Comfort and satisfaction during axillary brachial plexus block in trauma patients: comparison of techniques

Gianesello, Lara; Pavoni, Vittorio; Coppini, Roberta; Buoninsegni, Laura Tadini; Gori, Gabriele; Mori, Emanuele; Paparella, Laura; Gritti, Gaetano

doi:10.1016/j.jclinane.2009.02.010

« Previous Next »Journal of Clinical Anesthesia
Volume 22, Issue 1 , Pages 7-12, February 2010

Comfort and satisfaction during axillary brachial plexus block in trauma patients: comparison of techniques☆

Department of Anesthesia and Intensive Care, Orthopedic and Traumatologic Center, University Hospital Careggi, 50139 Florence, Italy

Received 21 January 2008; received in revised form 2 February 2009; accepted 2 February 2009.

Abstract

Study Objective

To investigate the comfort and satisfaction of patients with trauma of the upper limb during two different techniques of axillary brachial plexus block, electrical nerve stimulation and fascial pop.

Design

Randomized-prospective, observational study.

Setting

University surgical center.

Patients

100 ASA physical status I and II patients undergoing surgery for trauma of the hand and forearm.

Interventions

Patients received axillary brachial plexus block with a mixture of 0.5% bupivacaine and 2% lidocaine. They were then allocated to one of two groups to receive either electrical nerve stimulation (Group 1, n = 50), or fascial pop technique (Group 2, n = 50) for nerve location.

Measurements

Data were collected on patient demographics, surgery, frequency of complications, and sedation required during the block. Discomfort during the block and surgical comfort were quantified by visual analog scale (0-10). Satisfaction was determined by the following scale: very satisfied, satisfied, dissatisfied, and very dissatisfied. Patients also indicated if in the future they would like to receive the same method of anesthesia.

Main Results

No differences in demographic or surgical data were found. No serious complications were observed. Eighteen Group 1 patients (36%) and none in Group 2 needed sedation during the blocks. Discomfort during the procedures was greater in Group 1 than Group 2 (4.5 ± 1.2 vs 1.5 ± 1, P < 0.05), while patients reported good surgical comfort with both techniques (2.4 ± 2.9 vs 2.2 ± 2.1, NS). Eighteen patients in Group 1 and 48 patients in Group 2 would accept the same block for future surgery.

Conclusions

In trauma patients, the fascial pop technique is effective, reduces sedation during axillary brachial plexus block, and has a higher patient acceptance rate than the electrical nerve stimulation technique.

Keywords: Anesthesia, regional, Axillary brachial plexus block, Electrical nerve stimulation, Fascial pop, Patient comfort, Patient satisfaction, Trauma patients.