Ultrasound-guided axillary brachial plexus block with 20 milliliters local anesthetic mixture versus general anesthesia for upper limb trauma surgery: an observer-blinded, prospective, randomized, controlled trial.
Affiliation
Department of Anesthesia, Cork University Hospital, Wilton Rd., Cork, Ireland. briodnl@gmail.comIssue Date
2009-07MeSH
AdultAnesthesia, General
Anesthetics, Local
Brachial Plexus
Female
Follow-Up Studies
Humans
Male
Middle Aged
Nerve Block
Prospective Studies
Trauma, Nervous System
Ultrasonography, Interventional
Upper Extremity
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Ultrasound-guided axillary brachial plexus block with 20 milliliters local anesthetic mixture versus general anesthesia for upper limb trauma surgery: an observer-blinded, prospective, randomized, controlled trial. 2009, 109 (1):279-83 Anesth. Analg.Journal
Anesthesia and analgesiaDOI
10.1213/ane.0b013e3181a3e721PubMed ID
19535722Additional Links
http://www.anesthesia-analgesia.org/content/109/1/279.full.pdf+htmlAbstract
We performed a randomized, controlled trial comparing low-dose ultrasound-guided axillary block with general anesthesia evaluating anesthetic and perioperative analgesic outcomes.Patients were randomized to either ultrasound-guided axillary block or general anesthesia. Ultrasound-guided axillary block was performed using a needle-out-of-plane approach. Up to 5 mL of local anesthetic injectate (equal parts 2% lidocaine with 1:200,000 epinephrine and 0.5% bupivacaine with 7.5 mg/mL clonidine) was injected after identifying the median, ulnar, radial, and musculocutaneous nerves. A maximum of 20 mL local anesthetic injectate was used. General anesthesia was standardized to include induction with fentanyl and propofol, maintenance with sevoflurane in an oxygen/nitrous oxide mixture. Pain scores were measured in the recovery room and at 2, 6, 24, 48 h, and 7 days. Ability to bypass the recovery room and time to achieve hospital discharge criteria were also assessed.
All ultrasound-guided axillary block patients achieved satisfactory anesthesia. The ultrasound-guided axillary block group had lower visual analog scale pain scores in the recovery room (0.3 [1.3] vs 55.8 [36.5], P < 0.001), and visual rating scale pain scores at 2 h (0.3 [1.3] vs 45 [29.6], P < 0.001), and at 6 h (1.1 [2.7] vs 4 [2.8], P < 0.01). All ultrasound-guided axillary block patients bypassed the recovery room and attained earlier hospital discharge criteria (30 min vs 120 min 30/240 P < 0.0001 median [range]).
Ultrasound-guided axillary brachial plexus block with 20 mL local anesthetic mixture provided satisfactory anesthesia and superior analgesia after upper limb trauma surgery when compared with general anesthesia.
Item Type
ArticleLanguage
enISSN
1526-7598ae974a485f413a2113503eed53cd6c53
10.1213/ane.0b013e3181a3e721
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