Key result
Distal nerve blocks linked to ~3x higher early discharge and faster onset vs brachial plexus blocks.
Why the study?
The study sought to compare distal nerve blocks against brachial plexus blocks regarding block success, block characteristics, time to discharge, and patient satisfaction in hand and wrist surgeries.
Do distal nerve blocks improve block-related characteristics and time to discharge compared to brachial plexus blocks in patients undergoing elective hand and wrist surgery?
Cohort (n=45)
Do distal nerve blocks improve block-related characteristics and time to discharge compared to brachial plexus blocks in patients undergoing elective hand and wrist surgery?
Absolute Event Rate: 50% vs 17.4%
p-value: p=<0.05
Distal nerve blocks provide faster block onset and earlier discharge compared to brachial plexus blocks for hand and wrist surgeries, with similar patient satisfaction.
May support distal blocks for faster discharge in hand surgery; leaves open confirmation via randomized trials.
Background: Ultrasound-guided brachial plexus blocks (BPB) are used as an anaesthetic method in hand and wrist surgeries. The radial, median and ulnar nerves can also be selectively blocked. The objective of this retrospective cohort study was to compare distal nerve blocks (DNB) and BPB in terms of block success, block-related characteristics, time to discharge and patient satisfaction. Methods: The data of patients who underwent elective hand and wrist surgery under regional anaesthetic procedures between 01.01.2022 and 01.09.2022 were analysed. Standard multimodal analgesia was performed in all groups, in addition to either ultrasound-guided BPB or DNB. Demographic characteristics, American Society of Anaesthesiology (ASA) classes, presence of additional diseases, block and volume applied, block-related data such as block performance time, onset time, initial analgesia times, perioperative additional anaesthetic or analgesic requirement, surgery times, types of surgery, discharge times and the presence of additional complaints were recorded. In addition, the anaesthesia quality score were determined using a 5-point Likert scale. Results: There was no difference between demographic data. Average surgical time was similar between the DNB and BPB groups (46.0 ± 8.92 vs. 59.95 ± 22.04 min, p < 0.05). Block onset time was significantly lower in the DNB group (26.4 ± 2.73 vs. 32.17 ± 2.94 min, p < 0.001). When patients discharged before and after 12 hours were compared, 11/22 of the patients in the DNB group and 4/23 of the patients in the BPB group were discharged in the first 12 hours (p < 0.05). Patient satisfaction scores were similar between groups (14.22 ± 0.86 vs. 13.65 ± 1.11, p > 0.05). Conclusions: In surgeries of the hand and wrist, the radial, median and ulnar nerves can be used individually or in combination as an alternative to proximal BPB. Level of Evidence: Level III (Therapeutic)
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CAKMAK et al. (2023) conducted a cohort in Elective hand and wrist surgery (n=45). Distal nerve blocks (DNB) vs. Brachial plexus blocks (BPB) was evaluated on Discharge in the first 12 hours (p=<0.05). Distal nerve blocks for hand and wrist surgery resulted in a higher rate of discharge within 12 hours (50% vs 17.4%, p<0.05) and faster block onset compared to brachial plexus blocks.
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