Purpose
We devised a low-concentration brachial plexus block (LCBB) that allows for intraoperative,
active motion by blocking only sensory nerves. This study evaluated the efficacy of
the LCBB.
Methods
Thirty-eight patients (14 men and 24 women; mean age, 60.0 years) underwent surgery
with the LCBB. An ultrasound-guided supraclavicular brachial plexus block with 30–40
mL of 0.6 mg/ml ropivacaine hydrochloride hydrate was performed approximately 2 hours
before starting the surgery. A local anesthetic (LA) was administered as a local infiltration
if the intraoperative pain relief was locally insufficient. The surgery was performed
using a tourniquet as usual, which was released for approximately 1 minute when there
was a requirement to check for intraoperative, active motion. We recorded the waiting
time required between LCBB administration and surgery, the total surgery time, the
total tourniquet time, the number of patients administered an LA, the total LA volume
(1% lidocaine equivalent), and the muscle strength at intraoperative, active motion
(evaluated by manual muscle testing and categorized as ≥grade 4 or ≤grade 3).
Results
The mean waiting time was 137.0 minutes, the mean surgery time was 124.6 minutes,
and the mean tourniquet time was 70.6 minutes. In 2 patients, the anesthetic effect
was not achieved, and we switched to other methods of anesthesia (1 patient was switched
to an intravenous, regional anesthesia; 1 patient was switched to a standard brachial
plexus block). Excluding those 2 cases, the mean LA volume was 8.7 mL among 22 cases
(61.1%), and 33 cases (91%) had manual muscle testing of ≥grade 4. In 36 of 38 cases
(94.7%), surgery could be performed by LCBB.
Conclusions
Although an LCBB may require additional LA, it is a useful anesthesia method that
allows intraoperative active motion and tourniquet use.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Published online: August 05, 2022
Accepted:
June 7,
2022
Received:
October 23,
2021
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
