title: Transition from nerve stimulator to sonographically guided axillary brachial plexus anesthesia in hand surgery: block quality and patient satisfaction during the transition period.
abstract: OBJECTIVE
  Sonographic guidance for peripheral nerve anesthesia has proven increasingly successful in clinical practice; however, fears that a change to sonographically guided regional anesthesia may impair the block quality and operating room work flow persist in certain units. In this retrospective cohort study, block quality and patient satisfaction during the transition period from nerve stimulator to sonographic guidance for axillary brachial plexus anesthesia in a tertiary referral center were investigated.
  
  
  METHODS
  Anesthesia records of all patients who had elective surgery of the wrist or hand during the transition time (September 1, 2006-August 25, 2007) were reviewed for block success, placement time, anesthesiologist training level, local anesthetic volume, and requirement of additional analgesics. Postoperative records were reviewed, and patient satisfaction was assessed by telephone interviews in matched subgroups.
  
  
  RESULTS
  Of 415 blocks, 341 were sonographically guided, and 74 were nerve stimulator guided. Sonographically guided blocks were mostly performed by novices, whereas nerve stimulator-guided blocks were performed by advanced users (72.3% versus 14%; P < .001). Block performance times and success rates were similar in both groups. In sonographically guided blocks, significantly less local anesthetics were applied compared to nerve stimulator-guided blocks (mean ± SD, 36.1 ± 7.1 versus 43.9 ± 6.1 mL; P< .001), and less opioids were required (fentanyl, 66.1 ± 30 versus 90 ± 62 μg; P< .001). Interviewed patients reported significantly less procedure-related discomfort, pain, and prolonged procedure time when block placement was sonographically guided (2% versus 20%; P = .002).
  
  
  CONCLUSIONS
  Transition from nerve stimulator to sonographic guidance for axillary brachial plexus blocks did not change block performance times or success rates. Patient satisfaction was improved even during the early institutional transition period.
authors.affiliation: Department of Anesthesiology and Pain Therapy, Bern University Hospital and University of Bern, Inselspital, Bern, Switzerland.
authors.forename: Cédric
authors.initials: C
authors.lastname: Luyet
authors.forename: Mihai
authors.initials: M
authors.lastname: Constantinescu
authors.forename: Manuel
authors.initials: M
authors.lastname: Waltenspül
authors.forename: Martin
authors.initials: M
authors.lastname: Luginbühl
authors.forename: Esther
authors.initials: E
authors.lastname: Vögelin
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage; D001365:Axilla / Q000000981:diagnostic imaging; D001917:Brachial Plexus; D003131:Combined Modality Therapy; D004599:Electric Stimulation Therapy / Q000706:statistics & numerical data*; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000706:statistics & numerical data*; D010149:Postoperative Pain / Q000453:epidemiology* / Q000517:prevention & control*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D018570:Risk Assessment; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000779:Anesthetics, Local