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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.

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    Authors
    O'Donnell, Brian D
    Ryan, Helen
    O'Sullivan, Owen
    Iohom, Gabrielle
    Affiliation
    Department of Anesthesia, Cork University Hospital, Wilton Rd., Cork, Ireland. briodnl@gmail.com
    Issue Date
    2009-07
    MeSH
    Adult
    Anesthesia, General
    Anesthetics, Local
    Brachial Plexus
    Female
    Follow-Up Studies
    Humans
    Male
    Middle Aged
    Nerve Block
    Prospective Studies
    Trauma, Nervous System
    Ultrasonography, Interventional
    Upper Extremity
    Show allShow less
    
    Metadata
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    Citation
    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 analgesia
    URI
    http://hdl.handle.net/10147/200984
    DOI
    10.1213/ane.0b013e3181a3e721
    PubMed ID
    19535722
    Additional Links
    http://www.anesthesia-analgesia.org/content/109/1/279.full.pdf+html
    Abstract
    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
    Article
    Language
    en
    ISSN
    1526-7598
    ae974a485f413a2113503eed53cd6c53
    10.1213/ane.0b013e3181a3e721
    Scopus Count
    Collections
    Cork University Hospital

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