2017 Volume 36 Issue 4 Pages 475-480
Objective: We created a low-concentration brachial plexus block (LCBB) technique in which only the sensory modality is blocked, and intraoperative active motion is enabled. This study aimed to evaluate the effectiveness of this technique.
Methods: Six patients with a mean age of 71.3 years underwent surgery by the LCBB technique. Three patients had osteoarthritis (OA) and three had rheumatoid arthritis (RA). One total wrist arthrodesis, one partial wrist arthrodesis, and four wrist arthroplasties (Sauve-Kapandji procedure) were performed with tendon reconstruction. Ultrasound-guided supraclavicular brachial plexus block with 30 mL of 0.06% ropivacaine was performed approximately 2 hours presurgery. Local anesthesia (LA) was administered if the analgesic effect was not sufficient intraoperatively. We investigated the waiting time after the LCBB technique to surgery (WT), total surgical time (ST), total tourniquet time of each surgery (total TT), each tourniquet time during a single surgery (TT), number of patients for whom LA was administered, and the total volume of LA that was administered.
Results: We assessed the intraoperative active motion and performed surgery in all patients. The mean WT was 131 min, mean ST was 177.6 min, mean total TT was 92.8 min, and mean TT was 69.6 min. LA administration was required in three patients, and the mean volume of LA was 15.6 mL
Conclusion: Operating on a subcutaneous tendon rupture caused by OA or RA often requires additional bone and joint surgery, such as arthroplasty, for tendon reconstruction. However, intraoperative active motion during tendon suturing is difficult to perform with Bier block or wide-awake surgery. In all cases in which performing Bier block or wide-awake surgery was considered difficult, intraoperative active motion could be assessed by the LCBB technique. Therefore, this study supports the effectiveness of the LCBB technique.
