Ultrasound-guided distal peripheral nerve blocks of the ulnar, median, and radial nerves in hand and wrist surgery: a descriptive case series

With the increasing prevalence of surgical centers, identifying the safest and most efficient anesthetic techniques is vital. Ultrasound-guided distal peripheral nerve block (US-DPNB) is a technique that has shown promise in published literature for blocking the ulnar, median, and radial nerves at the level of the forearm. This descriptive case series examines 50 patients who underwent hand or wrist surgery with a focus on outcomes following the application of US-DPNB. The technique used in this study was performed by an anesthesiologist, Dr. Angel Saavedra, at an outpatient surgical center. The purpose of this descriptive case series is to describe beneficial clinical outcomes and the feasibility of blocking the median, ulnar, and radial nerves at the level of the forearm in the context of hand and wrist surgeries in surgical centers. The primary outcomes included a pain scale from 1 to 5, block performance time, and postoperative complications. The secondary outcomes are tourniquet time, patient satisfaction, and return of hand movement. With IRB approval, patients were followed up for up to five days post-surgery to assess outcomes. Either a distal or proximal block was performed at the level of the forearm. Exclusion criteria included repeat surgery on the same hand, procedures expected to exceed 20 min of tourniquet time, and patients with pre-existing peripheral nerve disorders, or prior surgeries affecting nerve anatomy. Data were analyzed using descriptive statistics only; no inferential comparisons between groups were performed. The DFB group presented an average block time of 95.59s, whereas the PFB group presented a mean block time of 73.9s. The pain scores decreased in both groups over the five-day follow-up period. Notably, the only recorded complication was postoperative nausea in one patient in the PFB group. This descriptive case series demonstrates the feasibility of US-DPNB as a primary anesthetic technique for short-duration ambulatory hand and wrist procedures, with low complication rates and high patient satisfaction. As a study without a comparator group, claims regarding economic benefit cannot be formally established; however, the opioid-sparing profile and favorable outcomes observed support further investigation through controlled trials. 20245045