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ULTRASOUND GUIDED AXILLARY BRACHIAL PLEXUS BLOCK: NO INCREASE IN PAIN SCORES WITH LOWER VOLUME, SHORT ACTING LOCAL ANAESTHETIC AGENTS
ESRA Academy. Cavalier A. Sep 8, 2016; 138422; 0269 Topic: REGIONAL ANAESTHESIA (RA) TECHNIQUES - CLINICAL IMPLICATIONS
Dr. Alison Cavalier
Dr. Alison Cavalier

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Abstract
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Background and Aims:

The Queen Victoria Hospital is a tertiary referral hand trauma unit in Sussex, UK. Approximately 1000 procedures are performed under ultrasound guided axillary brachial plexus block (AB) annually. We compared pain scores in those undergoing high volume block with longer acting local anaesthetic (LA) agents with those receiving low volume, short acting LA blocks.

Methods:

All patients were adults undergoing day case hand surgery with upper limb tourniquet. The volume of LA, use of additives, use of additional peripheral nerve blocks and pain scores (intra-operative and post-operative) were recorded. Follow-up was by telephone. Pain scores were self-reported (using NRS 0-10).

Results:

29 ultrasound guided ABs in 2015 were compared with 38 ultrasound guided ABs in 2003/4. In 2003/4, the mean volume of LA was 37.6ml, compared with 19.3ml in 2015. The 2003/4 data showed greater use of LA mixtures, mostly bupivacaine and lignocaine, whereas in 2015 the preference was for a single short-acting agent: lignocaine. Adrenaline was a popular additive in both time periods. In the 2015 group peripheral nerve blocks (radial at mid-humerus, median and ulnar at forearm) were performed three times more frequently. There was no significant difference in pain scores during the procedure or post-operatively.

Conclusions:

We conclude that high quality blocks can be achieved with significantly reduced LA dosage. Intra-operative and post-operative pain scores were not significantly different with the use of shorter acting, lower dose agents. This is important where rescue blocks are required intra-operatively to avoid LA toxicity and conversion to general anaesthesia.

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