Forearm vs Brachial Plexus Blockade for Routine Hand and Wrist Surgery

• Status: Unknown status
• Trial end date: 2020-08-01
• Target enrollment: 0
• Participant gender: All

Summary

It is very common to perform nerve blocks for hand and wrist surgery. It allows the surgeon to perform the surgery and helps with pain control after surgery. This also means only light sedation is needed for the procedure instead of a general anesthetic, which speeds up recovery time.

There are 2 types of nerve blocks that can be done for hand and/or wrist surgery. The one that is done commonly now is where the whole arm is frozen with local anesthetic. Another option is to have a nerve block where only the arm from the elbow down is frozen. Either of these types of nerve blocks can be chosen to safely accomplish surgery of the hand or wrist. However, the best nerve block for hand and/or wrist surgery has not been decided yet.

In order to determine which block is best, the investigators will be looking at patient satisfaction with the experience, as well as the surgical conditions provided and overall safety.

It is thought that many patients may prefer the arm block below the elbow as it allows for greater mobility immediately following surgery, and the surgical conditions provided will be very similar to those of the full arm nerve block.

• Phase: N/A
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: University Health Network, Toronto
• Treatments: Anesthetics; Anesthetics, Local; Bupivacaine; Lidocaine

Criteria

Inclusion Criteria:

• Consented, English-speaking, adult patients (age > 18)

• American Society of Anesthesiologists (ASA) classification I-III

• BMI ≤ 38 kg/m2 (quality of US imaging deteriorates significantly with obesity)

• Patients undergoing hand and/or wrist surgery (except wrist arthroscopy)

Exclusion Criteria:

• Previous upper extremity nerve block

• Contra-indication to nerve blocks e.g., infection, bleeding diathesis, allergy to local anesthetics

• Existing chronic pain disorders or history of use of ≥ 30mg morphine or equivalent per day

• Pre-existing neurological deficits or peripheral neuropathy involving the operative upper extremity

• Pregnancy

• Any significant psychiatric conditions that may affect patient assessment

• Inability to tolerate a forearm tourniquet

• Wrist arthroscopy surgery (requires upper arm tourniquet)

• Inability to speak or understand English without an interpreter present