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Extent of Pain Relief with Ultrasound Guided Supraclavicular and Interscalene Nerve Blocks
Diulus, Lewis A MD, Shankaran, Vidya MD, Smith, Michael MD
SUMMA, Akron Ohio
2012-02-15
Presenter: Lewis Diulus
Affidavit:
The study and blocks were performed by two plastic surgery residents during their first year anesthesia rotation
Director Name: Douglas Wagner
Author Category: Chief Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
How does this presentation meet the established conference educational objectives?
1. The study demonstrated knowledge of post operative pain management for hand surgery.
2. The study improves the care of patients by giving them an evidence based time frame of how long a block will relieve pain and how satisfied patients before them were from receiving a block.
3. There is no length of time data on these blocks ion the literature
How will your presentation be used by practicing physicians in the audience?
This study allows plastic surgeon performing hand procedure to better educate their patients on the efficacy, safety and satisfaction of receiving a pre-operative analgesic block for post-operative pain control.
Background:
Interscalene(IS) and supraclavicular(SC) nerve blocks are the gold standard for post-operative analgesia in painful procedures involving the upper extremity. They provide long-lasting relief, lower incidence of N/V and sore throat, and expedited hospital discharge. Although the success of theses agents at providing analgesia has been established, any average length of relief has never been published. Therefore, the purpose of this study is to determine length of analgesia.
Methods:
Patient between 18-75 years, scheduled to undergo pre-operative (SC) or (IS) ultrasound guided blocks and upper extremity surgery were enrolled in the study. Patients received 30-40 cc of a Dexamethasone, Bupivacaine (0.5%), and Ropivacaine (1%). Patients received a post-operative questionnaire recording time when tingling in the extremity was noted, time when oral pain medication started, and time when pain first noted. We assessed patient's satisfaction with nerve block on a 3-point scale. Patients were contacted via telephone.
Results:
50 patients were evaluated. 13 IS and 37 SC blocks were performed. Tingling sensation was recorded at (18:22+/- 3:43) post block, narcotic pain medication was started (19:31+/-2:35), and pain was noted (22:53+/-4:11). 98% were extremely satisfied with the blocks performance. There was no significance seen between patient's co-morbidities or BMI and length of block action.
Conclusion:
Preoperative long lasting nerve blocks for shoulder, elbow, and hand surgery are a safe and reliable form of analgesia; they provide excellent postoperative pain control the day of surgery. Patients are extremely satisfied with effects of the block and are glad they choose to undergo this procedure.
