title: Efficacy and safety of ultrasound-guided distal blocks for analgesia without motor blockade after ambulatory hand surgery.
abstract: OBJECTIVE
  To assess the suitability of ultrasound-guided (USG), single-injection distal block(s) for pain management after outpatient hand and wrist bone surgery.
  
  
  METHODS
  We conducted a retrospective review of 125 of 198 consecutive ambulatory surgery patients who underwent hand and wrist bone surgery between June 2010 and January 2012. All patients received a USG axillary block using a short-acting local anesthetic (lidocaine) and secondary 1, 2, or 3 (median, radial, or ulnar) USG distal analgesic block(s) using a long-acting local anesthetic (ropivacaine). All patients were contacted by phone on the first postoperative day. All patients received a concomitant prescription of acetaminophen and nonsteroidal anti-inflammatory drugs with opioids as a rescue treatment. Effectiveness and duration of the distal nerve blocks, compliance with analgesic treatment and rescue opioids requirement, opioid-related side effects, prolonged upper limb motor block, quality of sleep on first postoperative night, and patient satisfaction were evaluated.
  
  
  RESULTS
  Most distal analgesic blocks were effective (120 of 125; 96%), with an average duration of nearly 12 hours On the first day after surgery, 28 patients (23%) had a numeric verbal scale greater than 3, although 14 of them had taken the rescue opioids. No patient reported prolonged motor blockade or insensate limb. Opioid-related side effects occurred in 23% of patients.
  
  
  CONCLUSIONS
  After hand and wrist bone surgery, USG selective distal blocks using a long-acting local anesthetic, combined with oral analgesics, were effective in a large majority of patients. However, pain control was suboptimal for some especially painful procedures such as wrist surgery, trapeziometacarpal arthrodesis, and finger amputation.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Anesthesiology, Intensive care and Outpatient Surgery Unit, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Orthopedic and Trauma Surgery, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Anesthesiology, New York University Hospital for Joint Diseases, New York, NY.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dufeu
authors.affiliation: Department of Anesthesiology, Intensive care and Outpatient Surgery Unit, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Orthopedic and Trauma Surgery, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Anesthesiology, New York University Hospital for Joint Diseases, New York, NY.
authors.forename: Florence
authors.initials: F
authors.lastname: Marchand-Maillet
authors.affiliation: Department of Anesthesiology, Intensive care and Outpatient Surgery Unit, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Orthopedic and Trauma Surgery, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Anesthesiology, New York University Hospital for Joint Diseases, New York, NY.
authors.forename: Arthur
authors.initials: A
authors.lastname: Atchabahian
authors.affiliation: Department of Anesthesiology, Intensive care and Outpatient Surgery Unit, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Orthopedic and Trauma Surgery, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Anesthesiology, New York University Hospital for Joint Diseases, New York, NY.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Robert
authors.affiliation: Department of Anesthesiology, Intensive care and Outpatient Surgery Unit, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Orthopedic and Trauma Surgery, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Anesthesiology, New York University Hospital for Joint Diseases, New York, NY.
authors.forename: Yasmine
authors.initials: Y
authors.lastname: Ait Yahia
authors.affiliation: Department of Anesthesiology, Intensive care and Outpatient Surgery Unit, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Orthopedic and Trauma Surgery, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Anesthesiology, New York University Hospital for Joint Diseases, New York, NY.
authors.forename: Didier
authors.initials: D
authors.lastname: Milan
authors.affiliation: Department of Anesthesiology, Intensive care and Outpatient Surgery Unit, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Orthopedic and Trauma Surgery, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Anesthesiology, New York University Hospital for Joint Diseases, New York, NY.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Robert
authors.affiliation: Department of Anesthesiology, Intensive care and Outpatient Surgery Unit, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Orthopedic and Trauma Surgery, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Anesthesiology, New York University Hospital for Joint Diseases, New York, NY.
authors.forename: Marine
authors.initials: M
authors.lastname: Coroir
authors.affiliation: Department of Anesthesiology, Intensive care and Outpatient Surgery Unit, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Orthopedic and Trauma Surgery, St Antoine University Hospital, Assistance Publique, AP-HP, Paris, France; Department of Anesthesiology, New York University Hospital for Joint Diseases, New York, NY. Electronic address: marc.beaussier@sat.aphp.fr.
authors.forename: Marc
authors.initials: M
authors.lastname: Beaussier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000671:Amputation, Surgical; D000779:Anesthetics, Local; D001174:Arthrodesis; D001178:Arthroplasty; D005260:Female; D006225:Hand / Q000601:surgery; D006801:Humans; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D019637:Orthopedic Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D014955:Wrist Joint / Q000601:surgery; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine
keywords: Hand surgery; ambulatory surgery; postoperative pain; regional analgesia; ultrasound guidance