Tags

Type your tag names separated by a space and hit enter

Concomitant infraclavicular plus distal median, radial, and ulnar nerve blockade accelerates upper extremity anaesthesia and improves block consistency compared with infraclavicular block alone.
Br J Anaesth. 2011 Aug; 107(2):236-42.BJ

Abstract

BACKGROUND

This prospective, randomized, observer-blinded study tested the hypothesis that a combined ultrasound-guided block of the infraclavicular brachial plexus plus distal median, radial, and ulnar nerves would accelerate upper extremity anaesthesia compared with infraclavicular block alone.

METHODS

Elective wrist and hand surgery patients were randomly assigned to receive 42 ml infraclavicular lidocaine 1.5% with epinephrine 1/200,000 ('infraclavicular only'; n=30) or 30 ml lidocaine 1.5% with epinephrine 1/200,000 followed by a distal median, radial, and ulnar nerve block using 12 ml 50:50 lidocaine 2%+ropivacaine 0.75% ('combined'; n=31). A blinded observer assessed pinprick sensory and motor block in the four distal nerve territories at 10 and 15 min (each nerve/parameter: no block, 3, to complete block, 0).

RESULTS

Total aggregate block score (sensory+motor) was reduced in the combined group at 15 min [mean (95% confidence interval)=6.7 (5.3-8.1) vs. 9.9 (7.9-11.9), mean difference (95% confidence interval)=3.2 (0.81-5.6), P=0.01], and corresponded to an estimated onset effect time benefit of 6 min (∼40% treatment effect). The combined group also demonstrated reduced variance about the mean (sd=3.7 vs. 5.4, P=0.046). Mean (sd) total block score (sensory+motor) was significantly reduced at 15 min in the combined group for each individual nerve [median, radial, ulnar, respectively: 1.4 (1.1) vs. 2.4 (1.5), P=0.005; 1.2 (1.1) vs. 2.0 (1.5), P=0.03; 1.6 (1.3) vs. 2.5 (1.6), P=0.03].

CONCLUSIONS

At an approximately equivalent total local anaesthetic dose, a combined infraclavicular block plus distal median, radial, and ulnar nerve blockade accelerates anaesthesia onset time and improves block consistency compared with an infraclavicular block alone.

CLINICAL TRIALS REGISTRY

ANZCTR: ACTRN12610000155099. https://www.anzctr.org.au/registry/trial_review.aspx?ID=335162.

Authors+Show Affiliations

Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Epsom, Auckland, New Zealand.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21576095

Citation

Fredrickson, M J., et al. "Concomitant Infraclavicular Plus Distal Median, Radial, and Ulnar Nerve Blockade Accelerates Upper Extremity Anaesthesia and Improves Block Consistency Compared With Infraclavicular Block Alone." British Journal of Anaesthesia, vol. 107, no. 2, 2011, pp. 236-42.
Fredrickson MJ, Ting FS, Chinchanwala S, et al. Concomitant infraclavicular plus distal median, radial, and ulnar nerve blockade accelerates upper extremity anaesthesia and improves block consistency compared with infraclavicular block alone. Br J Anaesth. 2011;107(2):236-42.
Fredrickson, M. J., Ting, F. S., Chinchanwala, S., & Boland, M. R. (2011). Concomitant infraclavicular plus distal median, radial, and ulnar nerve blockade accelerates upper extremity anaesthesia and improves block consistency compared with infraclavicular block alone. British Journal of Anaesthesia, 107(2), 236-42. https://doi.org/10.1093/bja/aer101
Fredrickson MJ, et al. Concomitant Infraclavicular Plus Distal Median, Radial, and Ulnar Nerve Blockade Accelerates Upper Extremity Anaesthesia and Improves Block Consistency Compared With Infraclavicular Block Alone. Br J Anaesth. 2011;107(2):236-42. PubMed PMID: 21576095.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Concomitant infraclavicular plus distal median, radial, and ulnar nerve blockade accelerates upper extremity anaesthesia and improves block consistency compared with infraclavicular block alone. AU - Fredrickson,M J, AU - Ting,F S H, AU - Chinchanwala,S, AU - Boland,M R, Y1 - 2011/05/15/ PY - 2011/5/18/entrez PY - 2011/5/18/pubmed PY - 2011/9/8/medline SP - 236 EP - 42 JF - British journal of anaesthesia JO - Br J Anaesth VL - 107 IS - 2 N2 - BACKGROUND: This prospective, randomized, observer-blinded study tested the hypothesis that a combined ultrasound-guided block of the infraclavicular brachial plexus plus distal median, radial, and ulnar nerves would accelerate upper extremity anaesthesia compared with infraclavicular block alone. METHODS: Elective wrist and hand surgery patients were randomly assigned to receive 42 ml infraclavicular lidocaine 1.5% with epinephrine 1/200,000 ('infraclavicular only'; n=30) or 30 ml lidocaine 1.5% with epinephrine 1/200,000 followed by a distal median, radial, and ulnar nerve block using 12 ml 50:50 lidocaine 2%+ropivacaine 0.75% ('combined'; n=31). A blinded observer assessed pinprick sensory and motor block in the four distal nerve territories at 10 and 15 min (each nerve/parameter: no block, 3, to complete block, 0). RESULTS: Total aggregate block score (sensory+motor) was reduced in the combined group at 15 min [mean (95% confidence interval)=6.7 (5.3-8.1) vs. 9.9 (7.9-11.9), mean difference (95% confidence interval)=3.2 (0.81-5.6), P=0.01], and corresponded to an estimated onset effect time benefit of 6 min (∼40% treatment effect). The combined group also demonstrated reduced variance about the mean (sd=3.7 vs. 5.4, P=0.046). Mean (sd) total block score (sensory+motor) was significantly reduced at 15 min in the combined group for each individual nerve [median, radial, ulnar, respectively: 1.4 (1.1) vs. 2.4 (1.5), P=0.005; 1.2 (1.1) vs. 2.0 (1.5), P=0.03; 1.6 (1.3) vs. 2.5 (1.6), P=0.03]. CONCLUSIONS: At an approximately equivalent total local anaesthetic dose, a combined infraclavicular block plus distal median, radial, and ulnar nerve blockade accelerates anaesthesia onset time and improves block consistency compared with an infraclavicular block alone. CLINICAL TRIALS REGISTRY: ANZCTR: ACTRN12610000155099. https://www.anzctr.org.au/registry/trial_review.aspx?ID=335162. SN - 1471-6771 UR - https://www.unboundmedicine.com/medline/citation/21576095/Concomitant_infraclavicular_plus_distal_median_radial_and_ulnar_nerve_blockade_accelerates_upper_extremity_anaesthesia_and_improves_block_consistency_compared_with_infraclavicular_block_alone_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(17)33121-5 DB - PRIME DP - Unbound Medicine ER -