The use of a selective axillary nerve block for outpatient hand surgery

Anesthesia and Analgesia
H BouazizD Benhamou

Abstract

Although no guidelines concerning discharge criteria after axillary plexus block are available, many institutions consider recovery of motor function as a critical factor. With the midhumeral approach, the four main nerves of the upper extremity can be blocked separately using a peripheral nerve stimulator. The aim of this double-blind study was to block the radial (R) and musculocutaneous (MC) nerves with lidocaine, and the median (M) and ulnar (U) nerves with bupivacaine to recover motor function of the elbow and wrist more rapidly while maintaining long-lasting postoperative analgesia at the operative site. Patients undergoing surgery for Dupuytren's contracture were randomized into two groups in a double-blind fashion: in the control group (n = 17), each of the four nerves was infiltrated with 10 mL of a mixture of 2% lidocaine and 0.5% bupivacaine, whereas in the selective group (n = 17), the R and MC nerves were blocked with 10 mL of 2% lidocaine each and the M and U nerves were blocked with 10 mL of 0.5% bupivacaine each. Recovery of motor block was significantly faster in the selective group (231 +/- 91 vs 466 +/- 154 min). However, time to first sensation of pain was not different between groups (707 +/- 274 vs 706 +/-...Continue Reading

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Citations

Aug 12, 1999·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Z J Koscielniak-NielsenM Stenør
Sep 4, 2004·Annales Françaises D'anesthèsie Et De Rèanimation·A DeleuzeM E Gentili
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Mar 14, 2009·Regional Anesthesia and Pain Medicine·Joseph M NealQuinn H Hogan
Jun 27, 2013·Indian Journal of Orthopaedics·Prakash Khanchandani, Alejandro Badia
Oct 29, 2005·Annales Françaises D'anesthèsie Et De Rèanimation·L-J Dupré
Mar 15, 2005·Anesthesiology Clinics of North America·Holly EvansStephen M Klein
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Nov 15, 2008·Current Opinion in Anaesthesiology·Brian D O'Donnell, Gabriella Iohom
Oct 1, 2010·International Anesthesiology Clinics·Brian D O'Donnell, Gabriella Iohom
Nov 23, 2005·Anesthesia and Analgesia·Stephen M KleinSusan M Steele
Oct 4, 2006·Current Opinion in Anaesthesiology·G P Joshi

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