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초록
Purpose:
The purpose of this study was to evaluate the usefulness of ultrasound-guided axillary brachial plexus block performed by orthopedic surgeon as an anesthetic method for distal radius fracture surgery.
Methods:
From October 2017 to October 2018, an ultrasound-guided axillary brachial plexus block was performed on 161 cases of distal radius fracture requiring surgery. The procedure was performed by orthopedic surgeons using solution (20 mL of lidocaine HCl in 2%, 20 mL of ropivacaine in 0.75%, and 10 mL of normal saline in 0.9%). The success rate of the anesthetic procedure, the duration of analgesic effect, and the complications were investigated. If the anesthesia induction failed, additional local anesthetic methods were performed stepwise and reassessment about whether the operation could proceed was made.
Results:
Anesthesia was successful in 155 patients and the success rate was 96.3%. The duration of analgesic effect was 6 hours (3-10 hours). In 6 failed cases of anesthesia, local anesthesia was applied to the pain site in the operating room. In 5 cases, the operation was completed without discomfort. In 1 case complaining of pain around fracture site after the local anesthesia, ultrasound-guided radial nerve block was effective in controlling the pain.
Conclusion:
In open surgery of distal radius fractures, an ultrasound-guided axillary brachial plexus block performed by orthopedic surgeon allows anesthesia with high success rates. Even if the surgical anesthesia is incomplete, it is expected that the surgery cab be completed safely if the nerve is identified and the stepwise additional local anesthesia method is performed.
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Fig. 1.
Anesthetic preparation composed of lidocaine HCl 2% 20 mL, ropivacaine 0.75% 20 mL, 0.9% normal saline 10 mL, 50 mL syringe, 23-guage spinal needle, and intravenous extension line.
Fig. 2.
Patient position and the location of the probe for performing axillary brachial plexus block.
Fig. 3.
Ultrasound anatomy of the axilla. AA: axillary artery, CBM: coracobrachialis muscle, M: median nerve, MC: musculocutaneous nerve, R: radial nerve, U: ulnar nerve.
Fig. 4.
(A) In-plane needle approaching (arrowheads). (B) Complete block of the four nerves was performed. Hypoechoic areas surrounding each nerve was seen. CBM: coracobrachialis muscle, MC: musculocutaneous nerve, AA: axillary artery, M: median nerve, R: radial nerve, U: ulnar nerve.
Fig. 5.
Patient position (90 degree abduction and slightly internal rotation of the arm) and the location of the probe using aseptic cover and needle for performing radial nerve block.
Fig. 6.
The location of the ultrasound device and the position of the physician for performing radial nerve block.
Fig. 7.
(A) In-plane needle approaching (arrowheads) for performing radial nerve block. Radial nerve and humerus were seen. (B) The hypoechoic area of the local anesthetics was seen around the radial nerve after performing radial nerve block. R: radial nerve, LA: local anesthetics.
Fig. 8.
Flowchart of the supplemental local anesthesia for the distal radius fracture surgery. US-ABPB: ultrasound-guided axillary brachial plexus block, SA: surgical anesthesia, LA: local anesthesia, PFSI: peri-fracture site injection, US-RNB: ultra-sound-guided radial nerve block.
Table 1.
Demographic and clinical characteristics of patients (October 2017 to October 2018)
| Variable | Value |
|---|---|
| No. of patient | 161 |
| Sex (male:female) | 37:124 |
| Age (yr) | 63.4 (23-78) |
| Fracture type (A:B:C)∗ | 27:52:82 |
| Injured side (dominant:non-dominant) | 112:49 |
Table 2.
Summary of the patients who failed the musculocutaneous nerve block
| Age (yr)/ sex | Anatomical variation of MCN | Injection of supplemental LA at incision site (mL) | VAS (before injection/ after injection) |
|---|---|---|---|
| 57/male | None | 4 | 4/0 |
| 62/female | None | 5 | 5/0 |
Table 3.
Summary of the patients who failed the radial nerve block
Table 4.
Results of ultrasound-guided axillary brachial plexus block and tourniquet time (n=161)
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