Efficacy and Safety of Ultrasound-Guided Distal Blocks for Analgesia Without Motor Blockade After Ambulatory Hand Surgery

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• 作者：Nicolas Dufeu ; MD ; Florence Marchand-Maillet ; MD ; Arthur Atchabahian ; MD ; Nicolas Robert ; MD ; Yasmine Ait Yahia ; MD ; Didier Milan ; MD ; Cyrille Robert ; MD ; Marine Coroir ; MD ; Marc Beaussier ; MD ; PhD ; ^{marc.beaussier@sat.aphp.fr" class="auth_mail}
• 关键词：Hand surgery ; ambulatory surgery ; postoperative pain ; regional analgesia ; ultrasound guidance
• 刊名：The Journal of Hand Surgery
• 出版年：April, 2014
• 年：2014
• 卷：39
• 期：4
• 页码：737-743
• 全文大小：145 K

文摘

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Purpose

To assess the suitability of ultrasound-guided (USG), single-injection distal block(s) for pain management after outpatient hand and wrist bone surgery.

Methods

We conducted a retrospective review of 125 of 198 consecutive ambulatory surgery patients who underwent hand and wrist bone surgery between June 2010 and January 2012. All patients received a USG axillary block using a short-acting local anesthetic (lidocaine) and secondary 1, 2, or 3 (median, radial, or ulnar) USG distal analgesic block(s) using a long-acting local anesthetic (ropivacaine). All patients were contacted by phone on the first postoperative day. All patients received a concomitant prescription of acetaminophen and nonsteroidal anti-inflammatory drugs with opioids as a rescue treatment. Effectiveness and duration of the distal nerve blocks, compliance with analgesic treatment and rescue opioids requirement, opioid-related side effects, prolonged upper limb motor block, quality of sleep on first postoperative night, and patient satisfaction were evaluated.

Results

Most distal analgesic blocks were effective (120 of 125; 96%), with an average duration of nearly 12 hours On the first day after surgery, 28 patients (23%) had a numeric verbal scale greater than 3, although 14 of them had taken the rescue opioids. No patient reported prolonged motor blockade or insensate limb. Opioid-related side effects occurred in 23% of patients.

Conclusions

After hand and wrist bone surgery, USG selective distal blocks using a long-acting local anesthetic, combined with oral analgesics, were effective in a large majority of patients. However, pain control was suboptimal for some especially painful procedures such as wrist surgery, trapeziometacarpal arthrodesis, and finger amputation.

Type of study/level of evidence

Therapeutic IV.