Background and Goals: Axillary brachial plexus block (ABPB) is the most widely used regional anesthesia technique for surgical procedures involving the hand and forearm. More studies were conducted to evaluate the successful of several techniques in sensory and motor blocks (1), but none have investigated patient's comfort during different axillary brachial block procedures, such as electrical nerve stimulation (ENS) and “fascial pop” (FP).
Materials and Methods: In 2 months, fifty patients (undergoing to arthrodeses, osteosyntheses, nerve and tendon sutures) were randomly allocated in two groups. In Group 1, a total of 40 ml of a mixture of 0.5% bupivacaine and 2% lidocaine, were administrated with ENS. In Group 2, the same volume was injected through three needles passing through the fascial. Age, sex, types of surgical procedures, % of complications, % of failure, used of drugs for sedation, were collected. Discomfort during the block and surgical comfort were quantified by VAS (0-10). On postoperative day one, each patient was asked to complete a questionnaire regarding satisfaction with the block experience (VAS from 0 very satisfied to 10 very dissatisfied). Even, patients indicated if would like to receive the same type of anaesthesia in the future. Data was analysed using SPSS for Window.
Results: There were not differences regarding age, sex, types of surgical procedure between two groups. No serious complications were observed. There was one block failure in Group 2 and none in Group 1. Discomfort during two block procedures was: 4.5 ± 1.2 for Group 1 and 1.5 ± 1 for Group 2 (p < 0.05), while patients reported good surgical comfort in both groups (2.4 ± 2.9 vs 2.2 ± 2.1, NS). 9 patients of Group 1 required sedation during block and none of Group 2. Satisfaction scores were the following (Group 1 vs Group 2): 8% vs 56% very satisfied, 8% vs 40% satisfied, 48% vs 4% dissatisfied and 36% vs 0% very dissatisfied. 4 patients in Group 1 and 24 patients in Group 2 would accept the same block for future hand surgery.
Conclusions: FP seems to be a technique well accepted by patients that reduces sedation's use during axillary block performance.
1 Waters JH, Leivers D, et al. Anesth Analg 1997; 84:773-776.