Purpose
To explore the incidence of failure of continuous peripheral nerve blockade (CPNB)
after upper extremity operations.
Methods
Patient data regarding postoperative CPNB were retrospectively obtained from our institution's
regional anesthesia database. Documented information on the first postoperative day
included pain assessment ratings (numerical verbal pain scale, patient-reported breakthrough
pain upon perceived return of sensation, appearance of the catheter site, complications,
time of return of sensation, day of return of sensation, residual blockade, patient
satisfaction with the block, and whether patient would receive the block again).
Results
A total of 207 patients received CPNB for postoperative analgesia. The failure rate
on the first postoperative day for infraclavicular (133 patients) and supraclavicular
(58 patients) CPNB was 19% and 26%, respectively. Interscalene CPNB (16 patients)
yielded 3 incidences of failure. No significant difference was found between supraclavicular
and infraclavicular block techniques. In addition, no significant differences were
found between the incidences of CPNB failures with potentially more painful surgeries
involving bone compared with potentially less painful soft tissue procedures.
Conclusions
The CPNB technique used for hand surgery postoperative analgesia was associated with
nontrivial failure rates. The potential of CPNB failure and resulting breakthrough
pain upon recovery from the primary nerve block is important to help establish patient
expectations.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Accepted:
November 4,
2013
Received:
September 14,
2013
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Secondary Block Failure for Upper Extremity Surgery: Less Is Not MoreJournal of Hand SurgeryVol. 39Issue 9
- PreviewWe write regarding the article by Ahsan and colleagues.1 When doing a continuous brachial plexus block, we place a catheter with ultrasound or nerve stimulator guidance on 1 of the 5 roots or 1 of the 3 trunks, in the case of interscalene block. A catheter can also be placed on 1 of the 6 divisions or 3 cords in the case of supra- or infraclavicular block and on 1 of the 7 peripheral nerves in the case of axillary block. However, the logic of the Hilton law of anatomy2 survives the test of time.
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