title: Can we gain an advantage by combining distal median, radial and ulnar nerve blocks with supraclavicular block? A randomized controlled study.
abstract: OBJECTIVE
  The aim of this study was to compare the combined ultrasound-guided supraclavicular brachial plexus block (SCB) and distal median, radial, and ulnar nerve blocks, with the supraclavicular block alone.
  
  
  METHODS
  Sixty-two patients undergoing upper extremity surgery were randomized to supraclavicular only (Group S, n = 31) or supraclavicular + distal (Group SD, n = 31) group. Patients in Group S received 32 mL of 1.5 % lidocaine + epinephrine 5 µg/mL, while those in Group SD received 20 mL of 1.5 % lidocaine + epinephrine 5 µg/mL followed by distal median, radial, and ulnar nerve blocks using equal volumes of 2 % lidocaine + 0.5 % levobupivacaine (4 mL/nerve). Sensory and motor blocks of the ulnar, median, radial and musculocutaneous nerves were assessed every 5 min starting at the 10th minute. The imaging, needling and performance times were recorded. Also, the onset and anesthesia-related times, need for analgesic and first analgesic times, were noted.
  
  
  RESULTS
  In Group SD, the anesthesia onset [15 (10-25) vs. 20 (15-30) min, p < 0.001] and anesthesia related times [16.6 (10.7-28.2) vs. 22 (15.9-33.7) min, p < 0.001] were significantly shorter than those of Group S. Additionally, the analgesic requirement was lower in Group SD (56.7 vs. 88.5 %, p = 0.009), while among the patients who required analgesic, the first analgesic time was longer in Group SD in comparison to Group S [625 (347-1764) vs. 315 (233-746) min p < 0.001].
  
  
  CONCLUSIONS
  The addition of distal median, radial, and ulnar nerve blocks to SCB shortens anesthesia-related time and anesthesia onset time when compared with a SCB alone.
authors.affiliation: Department of Anesthesiology and ICM, Ankara University Faculty of Medicine, Ankara, Turkey, basakceyda@hotmail.com.
authors.forename: Basak Ceyda
authors.initials: BC
authors.lastname: Meco
authors.forename: Menekse
authors.initials: M
authors.lastname: Ozcelik
authors.forename: Derya Gokmen
authors.initials: DG
authors.lastname: Oztuna
authors.forename: Mehmet
authors.initials: M
authors.lastname: Armangil
authors.forename: Cigdem Yildirim
authors.initials: CY
authors.lastname: Guclu
authors.forename: Sanem Cakar
authors.initials: SC
authors.lastname: Turhan
authors.forename: Feyhan
authors.initials: F
authors.lastname: Okten
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local; D001917:Brachial Plexus / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008012:Lidocaine; D008297:Male; D008475:Median Nerve / Q000000981:diagnostic imaging; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology; D011446:Prospective Studies; D011826:Radial Nerve / Q000000981:diagnostic imaging; D014459:Ulnar Nerve / Q000000981:diagnostic imaging; D018084:Ultrasonography, Interventional; D034941:Upper Extremity / Q000601:surgery; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine
references.citation: Anesthesiology. 2004 Aug;101(2):461-7
references.pmid: 15277930
references.citation: Anesth Analg. 2006 Feb;102(2):588-92
references.pmid: 16428567
references.citation: Br J Anaesth. 2011 Aug;107(2):236-42
references.pmid: 21576095
references.citation: Anesthesiology. 2007 May;106(5):992-6
references.pmid: 17457131
references.citation: Reg Anesth Pain Med. 2000 Jan-Feb;25(1):41-6
references.pmid: 10660239
references.citation: Reg Anesth Pain Med. 2002 Jul-Aug;27(4):402-28
references.pmid: 12132064
references.citation: Anaesthesia. 2009 Jul;64(7):738-44
references.pmid: 19624628
references.citation: Reg Anesth Pain Med. 2009 Sep-Oct;34(5):420-4
references.pmid: 19920418
references.citation: Acta Anaesthesiol Scand. 2009 May;53(5):620-6
references.pmid: 19419356
references.citation: Reg Anesth Pain Med. 2010 Jan-Feb;35(1):16-21
references.pmid: 20048654
references.citation: Reg Anesth Pain Med. 2009 Jul-Aug;34(4):366-71
references.pmid: 19574871
references.citation: Anesth Analg. 2005 Sep;101(3):886-890
references.pmid: 16116009
references.citation: Int J Clin Pharmacol Ther. 2010 Sep;48(9):608-13
references.pmid: 20860914
references.citation: Reg Anesth Pain Med. 2012 Jan-Feb;37(1):55-9
references.pmid: 22030724