title: Ultrasound-guided axillary brachial plexus block with 20 milliliters local anesthetic mixture versus general anesthesia for upper limb trauma surgery: an observer-blinded, prospective, randomized, controlled trial.
abstract: OBJECTIVE
  We performed a randomized, controlled trial comparing low-dose ultrasound-guided axillary block with general anesthesia evaluating anesthetic and perioperative analgesic outcomes.
  
  
  METHODS
  Patients were randomized to either ultrasound-guided axillary block or general anesthesia. Ultrasound-guided axillary block was performed using a needle-out-of-plane approach. Up to 5 mL of local anesthetic injectate (equal parts 2% lidocaine with 1:200,000 epinephrine and 0.5% bupivacaine with 7.5 mg/mL clonidine) was injected after identifying the median, ulnar, radial, and musculocutaneous nerves. A maximum of 20 mL local anesthetic injectate was used. General anesthesia was standardized to include induction with fentanyl and propofol, maintenance with sevoflurane in an oxygen/nitrous oxide mixture. Pain scores were measured in the recovery room and at 2, 6, 24, 48 h, and 7 days. Ability to bypass the recovery room and time to achieve hospital discharge criteria were also assessed.
  
  
  RESULTS
  All ultrasound-guided axillary block patients achieved satisfactory anesthesia. The ultrasound-guided axillary block group had lower visual analog scale pain scores in the recovery room (0.3 [1.3] vs 55.8 [36.5], P < 0.001), and visual rating scale pain scores at 2 h (0.3 [1.3] vs 45 [29.6], P < 0.001), and at 6 h (1.1 [2.7] vs 4 [2.8], P < 0.01). All ultrasound-guided axillary block patients bypassed the recovery room and attained earlier hospital discharge criteria (30 min vs 120 min 30/240 P < 0.0001 median [range]).
  
  
  CONCLUSIONS
  Ultrasound-guided axillary brachial plexus block with 20 mL local anesthetic mixture provided satisfactory anesthesia and superior analgesia after upper limb trauma surgery when compared with general anesthesia.
authors.affiliation: Department of Anesthesia, Cork University Hospital, Wilton Rd., Cork, Ireland. briodnl@gmail.com
authors.forename: Brian D
authors.initials: BD
authors.lastname: O'Donnell
authors.forename: Helen
authors.initials: H
authors.lastname: Ryan
authors.forename: Owen
authors.initials: O
authors.lastname: O'Sullivan
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Iohom
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001917:Brachial Plexus / Q000000981:diagnostic imaging / Q000187:drug effects / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D011446:Prospective Studies; D020196:Trauma, Nervous System / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D018084:Ultrasonography, Interventional / Q000379:methods*; D034941:Upper Extremity / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D000779:Anesthetics, Local