title: Ultrasound-guided block of selective branches of the brachial plexus for vascular access surgery in the forearm: a preliminary report.
abstract: OBJECTIVE
  The operative field for vascular access (VA) surgery in the forearm is on the volar surface, and motor nerve block is not necessary for regional anesthesia. Therefore, selective block of branches of the brachial plexus may be a more efficient anesthesia technique.
  
  
  METHODS
  Individual nerve blocks in the axillary brachial plexus and selective blocks of the musculocutaneous and medial antebrachial cutaneous nerves in the upper arm were performed using low doses and concentrations of a local anesthetic mixture of lidocaine and ropivacaine under ultrasound (US) guidance in patients undergoing VA surgery in the forearm. The targeted nerves were identified by continuous US tracing along the upper arm to the axilla in a short-axis view. We performed three VA surgeries in the forearm using an axillary brachial plexus block and four using a selective two-nerve bock in the upper arm. We recorded any additional anesthetic requirement and evaluated intraoperative pain using the Wong-Baker Faces Pain Rating Scale (WBFRS; 0 = no pain; 10 = worst pain).
  
  
  RESULTS
  All of the target nerve branches were clearly identified by US tracing. All patients had satisfactory intraoperative pain control (0 or 2 score on WBFRS). Four patients required small additional doses of local anesthetic.
  
  
  CONCLUSIONS
  US-guided block of individual branches of the brachial plexus at the axilla achieved effective anesthesia using small amounts of local anesthetic. An advanced selective nerve block in the upper arm allows minimum necessary anesthesia and provides safe and efficient analgesia for VA surgery in the forearm.
authors: Department of Surgery, Saiwaicho Memorial Hospital, Okayama - Japan.
authors: Hiroaki
authors: H
authors: Matsuda
authors: Department of Surgery, Saiwaicho Memorial Hospital, Okayama - Japan.
authors: Yoshinari
authors: Y
authors: Oka
authors: Department of Internal Medicine, Saiwaicho Memorial Hospital, Okayama - Japan.
authors: Shigeko
authors: S
authors: Takatsu
authors: Department of Gastroenterological Surgery, Okayama University of Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama - Japan.
authors: Ryoichi
authors: R
authors: Katsube
authors: Department of Gastroenterological Surgery, Okayama University of Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama - Japan.
authors: Ryuichi
authors: R
authors: Yoshida
authors: Department of Gastroenterological Surgery, Okayama University of Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama - Japan.
authors: Takanori
authors: T
authors: Oyama
authors: Department of Anesthesiology, Okayama University of Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama - Japan.
authors: Yoshimasa
authors: Y
authors: Takeda
authors: Department of Surgery, Saiwaicho Memorial Hospital, Okayama - Japan.
authors: Masashi
authors: M
authors: Miyazaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000008:administration & dosage* / Q000009:adverse effects; D019162:Anesthetics, Combined / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D065527:Brachial Plexus Block / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D010147:Pain Measurement; D017288:Pain Threshold / Q000187:drug effects; D010865:Pilot Projects; D000077212:Ropivacaine; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000577:Amides; D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D000077212:Ropivacaine; D008012:Lidocaine