title: Distal Peripheral Nerve Blocks in the Forearm as an Alternative to Proximal Brachial Plexus Blockade in Patients Undergoing Hand Surgery: A Prospective and Randomized Pilot Study.
abstract: OBJECTIVE
  Limited data exist regarding the role of perineural blockade of the distal median, ulnar, and radial nerves as a primary anesthetic in patients undergoing hand surgery. We conducted a prospective and randomized pilot study to compare these techniques to brachial plexus blocks as a primary anesthetic in this patient population.
  
  
  METHODS
  Sixty patients scheduled for hand surgery were randomized to receive either an ultrasound-guided supraclavicular, infraclavicular, or axillary nerve block (brachial plexus blocks) or ultrasound-guided median, ulnar, and radial nerve blocks performed at the level of the mid to proximal forearm (forearm blocks). The ability to undergo surgery without analgesic or local anesthetic supplementation was the primary outcome. Block procedure times, postanesthesia care unit length of stay, instances of nausea/vomiting, and need for narcotic administration were also assessed.
  
  
  RESULTS
  The 2 groups were similar in terms of the need for conversion to general anesthesia or analgesic or local anesthetic supplementation, with only 1 patient in the forearm block group and 2 in the brachial plexus block group requiring local anesthetic supplementation or conversion to general anesthesia. Similar durations in surgical and tourniquet times were also observed. Both groups reported similarly low numerical rating scale pain scores as well as the need for postoperative analgesic administration (2 patients in the forearm block group and 1 in the brachial plexus block group reported numerical rating scale pain scores > 0 and required opioid administration in the postanesthesia care unit). Block procedure characteristics were similar between the 2 groups.
  
  
  CONCLUSIONS
  Forearm blocks may be used as a primary anesthetic in patients undergoing hand surgery. Further research is warranted to determine the appropriateness of these techniques in patients undergoing surgery in the thumb or proximal to the hand.
  
  
  METHODS
  Therapeutic II.
authors.affiliation: Department of Anesthesiology, North Florida/South Georgia Veterans Health System/University of Florida, Gainesville, FL. Electronic address: jsoberon@anest.ufl.edu.
authors.forename: José R
authors.initials: JR
authors.lastname: Soberón
authors.affiliation: Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Crookshank
authors.affiliation: Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Bobby D
authors.initials: BD
authors.lastname: Nossaman
authors.affiliation: University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
authors.forename: Clint E
authors.initials: CE
authors.lastname: Elliott
authors.affiliation: Department of Orthopedic Surgery, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Leslie E
authors.initials: LE
authors.lastname: Sisco-Wise
authors.affiliation: Department of Orthopaedic Surgery, Boston University/Boston Medical Center, Boston, MA.
authors.forename: Scott F
authors.initials: SF
authors.lastname: Duncan
mesh_terms: D000328:Adult; D065527:Brachial Plexus Block / Q000379:methods*; D005260:Female; D005542:Forearm / Q000601:surgery*; D006225:Hand / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D010147:Pain Measurement; D010865:Pilot Projects; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: Distal peripheral nerve block(s); forearm block(s); hand surgery; nerve block(s); regional anesthesia