Delineation of distal ulnar nerve anatomy using ultrasound in volunteers to identify an optimum approach for neural blockade

Kathirgamanathan, Poopathy; French, J.; Foxall, G.; Hardman, Jonathan G.; Bedforth, N.

doi:10.1097/eja.0b013e328318c5b6

Cited by 14 publications

(10 citation statements)

References 12 publications

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“…Approximately the junction of the middle and proximal third of the forearm, proximal to the divergence from the ulnar artery. 7 The arm was abducted and externally rotated with the palm facing up. Needle advancement was in-plane anterior to posterior.…”

Section: Methodsmentioning

confidence: 99%

Concomitant infraclavicular plus distal median, radial, and ulnar nerve blockade accelerates upper extremity anaesthesia and improves block consistency compared with infraclavicular block alone

Fredrickson

Ting

Chinchanwala

et al. 2011

British Journal of Anaesthesia

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Section: Methodsmentioning

confidence: 99%

Concomitant infraclavicular plus distal median, radial, and ulnar nerve blockade accelerates upper extremity anaesthesia and improves block consistency compared with infraclavicular block alone

Fredrickson

Ting

Chinchanwala

et al. 2011

British Journal of Anaesthesia

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“…did not find a difference in patient satisfaction, whereas Lam et al [1] found a statistically significant difference in their study. The maintenance of motor function is an important advantage of distal nerve blocks because of the need to protect the arm operated on from inadvertent injury [10].…”

Section: Discussionmentioning

confidence: 99%

Can We Perform Distal Nerve Block Instead of Brachial Plexus Nerve Block Under Ultrasound Guidance for Hand Surgery?

2017

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Objective: Distal nerve blocks are used in the event of unsuccessful blocks as rescue techniques. The primary purpose of this study was to determine the sufficiency for anesthesia of distal nerve block without the need for deep sedation or general anesthesia. The secondary purpose was to compare block performance times, block onset times, and patient and surgeon satisfaction. Materials and Methods:Patients who underwent hand surgery associated with the innervation area of the radial and median nerves were included in the study. Thirty-four patients who were 18-65 years old and American Society of Anesthesiologists grade I-III and who were scheduled for elective hand surgery under conscious nerve block anesthesia were randomly included in an infraclavicular block group (Group I, n=17) or a radial plus median block group (Group RM, n=17). The block performance time, block onset time, satisfaction of the patient and surgeon, and number of fentanyl administrations were recorded. Results:The numbers of patients who needed fentanyl administration and conversion to general anesthesia were the same in Group I and Group RM and there was no statistically significant difference (p>0.05). The demographics, surgery times, tourniquet times, block perfomance times, and patient and surgeon satisfaction of the groups were similar and there were no statistically significant differences (p>0.05). There was a statistically significant difference in block onset times between the groups (p<0.05).Conclusions: Conscious hand surgery can be performed under distal nerve block anesthesia safely and successfully.Keywords: Distal nerve block, proximal nerve block, radial nerve, median nerve, brachial plexus ÖZ Amaç: Distal sinir blokları başarısız proksimal blok uygulamalarında tamamlayıcı blok olarak kullanılmaktadır. Bu çalışmanın primer amacı genel anestezi ve derin sedasyona ihtiyaç olmadan distal sinir bloklarının yeterli anestezi sağlayıp sağlamadığını değerlendirmektir. İkinci amacı ise blok uygulama ve blok gelişme zamanları, hasta ve cerrah memnuniyetlerini karşılaştırmaktır.Gereç ve Yöntem: 18-65 yaş, ASA I-III, Radial ve median sinir innervasyon alanlarını içeren elektif el cerrahisi geçirecek 34 hasta çalışmaya alındı ve hastalar randomize olarak infraklavikular blok grubu (Grup I, n=17) ve radial + median blok grubuna (Grup RM, n=17) dahil edildi. Blok uygulama ve blok gelişme zamanları ile hasta ve cerrah memnuniyetleri kayıt altına alındı.Bulgular: Genel anesteziye dönüş ve fentanil ihtiyacı olan hasta sayısı her iki grupta da aynıydı ve istatistiksel bir fark tespit edilmedi (p>0,05). Demografik veriler, ortalama cerrahi zamanı, turnike zamanı, blok uygulama zamanı, hasta ve cerrah memnuniyeti açısında gruplar arasında anlamlı bir istatistiksel fark yoktu (p>0,05). Blok gelişme zamanlarında ise gruplar arasında istatistiksel olarak anlamlı bir farklılık tespit edildi (p<0,05).Sonuç: Uyanık el cerrahisi distal sinir blokları ile güvenli ve başarılı bir şekilde uygulanabilir.Anahtar Kelimeler: Distal sinir bloğu, proks...

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“…A long axis slide was used to trace the median nerve distally to 5 cm from the proximal wrist crease [10]. A short axis slide was then performed medially to locate the ulnar artery and the ulnar nerve adjacent to it [12]. Upon location of these structures, 1.5 mL of 0.5% lidocaine with 5 mcg/mL epinephrine was injected subcutaneously at the medial border of the ultrasound probe.…”

Section: Methodsmentioning

confidence: 99%

A Triple-Masked, Randomized Controlled Trial Comparing Ultrasound-Guided Brachial Plexus and Distal Peripheral Nerve Block Anesthesia for Outpatient Hand Surgery

Lam

Charles

Mercer

et al. 2014

Anesthesiology Research and Practice

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Background. For hand surgery, brachial plexus blocks provide effective anesthesia but produce undesirable numbness. We hypothesized that distal peripheral nerve blocks will better preserve motor function while providing effective anesthesia. Methods. Adult subjects who were scheduled for elective ambulatory hand surgery under regional anesthesia and sedation were recruited and randomly assigned to receive ultrasound-guided supraclavicular brachial plexus block or distal block of the ulnar and median nerves. Each subject received 15 mL of 1.5% mepivacaine at the assigned location with 15 mL of normal saline injected in the alternate block location. The primary outcome (change in baseline grip strength measured by a hydraulic dynamometer) was tested before the block and prior to discharge. Subject satisfaction data were collected the day after surgery. Results. Fourteen subjects were enrolled. Median (interquartile range [IQR]) strength loss in the distal group was 21.4% (14.3, 47.8%), while all subjects in the supraclavicular group lost 100% of their preoperative strength, P = 0.001. Subjects in the distal group reported greater satisfaction with their block procedures on the day after surgery, P = 0.012. Conclusion. Distal nerve blocks better preserve motor function without negatively affecting quality of anesthesia, leading to increased patient satisfaction, when compared to brachial plexus block.

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Delineation of distal ulnar nerve anatomy using ultrasound in volunteers to identify an optimum approach for neural blockade

Abstract: Our study demonstrates that ultrasound can be utilized to identify the ulnar nerve and artery in the forearm. This implies that traditional landmarks will not be required prior to neural blockade. We have suggested a point for blockade of the nerve to reduce risk of vascular puncture.

Cited by 14 publications

References 12 publications

Concomitant infraclavicular plus distal median, radial, and ulnar nerve blockade accelerates upper extremity anaesthesia and improves block consistency compared with infraclavicular block alone

Concomitant infraclavicular plus distal median, radial, and ulnar nerve blockade accelerates upper extremity anaesthesia and improves block consistency compared with infraclavicular block alone

Can We Perform Distal Nerve Block Instead of Brachial Plexus Nerve Block Under Ultrasound Guidance for Hand Surgery?

A Triple-Masked, Randomized Controlled Trial Comparing Ultrasound-Guided Brachial Plexus and Distal Peripheral Nerve Block Anesthesia for Outpatient Hand Surgery

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