Landmark Technique for a Wrist Block

Effectiveness of Regional Nerve Blocks Versus Local Anesthetic Infiltration for Elective Hand and Wrist Surgery

BACKGROUND

Pain relief by different methods in elective hand and wrist surgery is pivotal for patients undergoing elective wrist and hand surgery.

AIM

To evaluate the effectiveness and duration of peripheral nerve block versus local surgical site anesthetic infiltration among patients undergoing elective wrist and hand surgery.

SUBJECTS AND METHODS

This study was carried out in the Orthopaedic Department of Duhok Emergency Teaching Hospital, Duhok, Kurdistan region, Iraq. All patients who attended the Orthopaedic Department (total number=496) for elective hand and wrist surgery between November 2021 and November 2022 were included in the study, but only 300 patients completed the study protocol after the exclusion of 196 patients. Three methods of nerve block were used for postoperative pain relief. The degree and duration of pain relief were assessed.

RESULTS

Patients who underwent ultrasound-guided nerve block had more duration of pain relief when compared to those patients who underwent local surgical site anesthetic infiltration and anatomical landmark nerve block (p<0.01), while patients who underwent local surgical site anesthetic infiltration had better pain relief when compared to those patients who underwent ultrasound-guided nerve block and anatomical landmark nerve block (p<0.01 for the group experiencing mild pain and p=0.12 for the group experiencing moderate pain and p<0.01 for the group experiencing severe pain).

CONCLUSION

Ultrasound-guided nerve block is better for a longer duration of pain relief postoperatively than local surgical site anesthetic infiltration, while local surgical site anesthetic infiltration more effectively controls the severity of pain following elective hand and wrist surgery.

[Distal hand block]

OBJECTIVE

Peripheral nerve blocks in hand surgery.

INDICATIONS

Short operations on the hand.

CONTRAINDICATIONS

Long operations, polyneuropathy, local anesthesia allergy.

TECHNIQUE

Identification of landmarks, skin disinfection, local anesthesia injection, surgery.

POSTOPERATIVE MANAGEMENT

Postoperative monitoring.

RESULTS

We performed 75 hand surgeries using distal nerve blocks over 3 years (between 2015 and 2018) in our department. In all, 60% (n = 45) of cases belong to the innervation region of the median nerve, 28% of cases (n = 21) belong to the innervation area of the radial nerve and about 5% (n = 4) to the innervation area of the ulnar nerve. In 7% (n = 5) of cases, anesthesia of two neighboring innervation areas was necessary. The distal nerve block provides a reliable form of anesthesia in hand surgery with low complication rates.