A triple-masked, randomized controlled trial comparing ultrasound-guided brachial plexus and distal peripheral nerve block anesthesia for outpatient hand surgery.
Background. For hand surgery, brachial plexus blocks provide effective anesthesia but produce undesirable numbness. We hypothesized that distal peripheral nerve blocks will better preserve motor function while providing effective anesthesia. Methods. Adult subjects who were scheduled for elective ambulatory hand surgery under regional anesthesia and sedation were recruited and randomly assigned to receive ultrasound-guided supraclavicular brachial plexus block or distal block of the ulnar and median nerves. Each subject received 15 mL of 1.5% mepivacaine at the assigned location with 15 mL of normal saline injected in the alternate block location. The primary outcome (change in baseline grip strength measured by a hydraulic dynamometer) was tested before the block and prior to discharge. Subject satisfaction data were collected the day after surgery. Results. Fourteen subjects were enrolled. Median (interquartile range [IQR]) strength loss in the distal group was 21.4% (14.3, 47.8%), while all subjects in the supraclavicular group lost 100% of their preoperative strength, P = 0.001. Subjects in the distal group reported greater satisfaction with their block procedures on the day after surgery, P = 0.012. Conclusion. Distal nerve blocks better preserve motor function without negatively affecting quality of anesthesia, leading to increased patient satisfaction, when compared to brachial plexus block.
Department of Anesthesiology & Critical Care Medicine, University of New Mexico, Albuquerque, NM 87131, USA.
Nicholas C K
NC
Lam
Department of Anesthesiology & Critical Care Medicine, University of New Mexico, Albuquerque, NM 87131, USA.
Matthew
0000-0001-5902-7206
M
Charles
Department of Orthopaedics & Rehabilitation, University of New Mexico, Albuquerque, NM 87131, USA.
Deana
D
Mercer
Department of Anesthesiology & Critical Care Medicine, University of New Mexico, Albuquerque, NM 87131, USA.
Codruta
C
Soneru
Department of Anesthesiology & Critical Care Medicine, University of New Mexico, Albuquerque, NM 87131, USA.
Jennifer
J
Dillow
Department of Anesthesiology & Critical Care Medicine, University of New Mexico, Albuquerque, NM 87131, USA.
Francisco
F
Jaime
Department of Anesthesiology & Critical Care Medicine, University of New Mexico, Albuquerque, NM 87131, USA ; Department of Anthropology, University of New Mexico, Albuquerque, NM 87131, USA.
Timothy R
TR
Petersen
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA ; Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue (112A), Palo Alto, CA 94304, USA.
Edward R
ER
Mariano