Key result
Age ≥40 years, male gender, elevated ALT, and GFR <60 mL/min were significant risk factors for prolonged duration (≥5 hours) of ultrasound-guided brachial plexus block in upper limb fracture surgery.
Why the study?
Previous studies included confounding surgical procedures or anesthetic approaches, and no study based on a single anesthetic method had explored factors affecting brachial plexus block resolution during upper limb surgery, especially in Asians.
What are the risk factors for prolonged duration of ultrasound-guided brachial plexus block in patients undergoing upper limb fracture surgery?
Cross-Sectional (n=129)
No
What are the risk factors for prolonged duration of ultrasound-guided brachial plexus block in patients undergoing upper limb fracture surgery?
Odds Ratio: 22.7 (95% CI 1.994–198.386)
p-value: p=0.012
Older age, male gender, elevated ALT, and reduced GFR are associated with prolonged duration of ultrasound-guided brachial plexus block in upper limb fracture surgery.
These factors may predict prolonged block duration but should not yet change practice; hypothesis-generating for prospective dosing studies.
Background: Previous studies of factors associated with prolonged duration of ultrasound-guided brachial plexus block have included multiple surgical procedures or multiple anesthetic approaches, all of which are important confounders, and there is no study based on a single method of anesthesia exploring the factors affecting the resolution of brachial plexus block during upper limb surgery, especially in Asians. This study aimed to identify the risk factors affecting the prolonged duration of US-guided brachial plexus block in American Society of Anesthesiologists (ASA) I-II grade patients to improve postoperative analgesia. Methods: This study enrolled patients scheduled to undergo surgery for upper limb fracture in Anting Hospital, Shanghai from May 2021 to September 2021. Inclusion criteria: (I) patients aged 18 years and above; (II) ASA I-II grade patients; (III) success of US-guided brachial plexus block. Based on the median duration of brachial plexus block, patients were divided into a <5-hour group and a ≥5-hour group. The factors were selected base on previous studies conclution and clinical demographic characteristics of patients. Multivariable logistic regression was used to estimate relevant influencing factors. Results: A total of 129 patients (51.2% males; 51.01±16.54 years old) were analyzed. The duration of brachial plexus block was 2-12 hours, with a median duration of 5.09 hours. Multivariable analysis suggested that age 40-49 years [odds ratio (OR): 4.841; 95% confidence interval (CI): 1.033 to 22.695; P=0.045], 50-59 years (OR: 4.730, 95% CI: 1.149 to 19.474; P=0.031), 60 years (OR: 8.540; 95% CI: 1.605 to 45.449; P=0.012), gender (OR: 3.314; 95% CI: 1.330 to 8.257; P=0.010), alanine aminotransferase (ALT; OR: 5.817, 95% CI: 1.509 to 22.472; P=0.011), and glomerular filtration rate (GFR) <60 (OR: 22.700; 95% CI: 1.994 to 198.386; P=0.012) were the risk factors for the duration of brachial plexus block. Conclusions: It is advisable to use the lowest effective dose for the shortest possible time when using ropivacaine in upper limb fracture surgery patients with elevated ALT (≥40 U/L) and lower GFR (<60 mL/min) in male patients aged ≥60 years.
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Li et al. (2023) conducted a cross-sectional in upper limb fracture surgery (n=129). Age, male gender, elevated ALT, and decreased GFR vs. Absence of these risk factors was evaluated on Prolonged duration of brachial plexus block (≥5 hours) (OR 22.700, 95% CI 1.994-198.386, p=0.012). Age ≥40 years, male gender, elevated ALT, and GFR <60 mL/min were significant risk factors for prolonged duration (≥5 hours) of ultrasound-guided brachial plexus block in upper limb fracture surgery.
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