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Objective: Continuous brachial plexus block is part of multimodal analgesia for upper extremity surgery. This study evaluated the efficacy and complication rate of continuous ultrasound-guided brachial plexus analgesia for postoperative pain management after upper extremity surgery.
Material and Method: This prospective case series included >18-years old, ASA I-III patients, scheduled for upper extremity surgery. Depending on the surgical approach (upper or lower arm) ltrasound-guided interscalene or infraclavicular brachial plexus catheter (IS, IC) were applied. For both techniques 10 ml of lidocaine 2% with epinephrine 5 mg/ml was injected and followed by 10 ml (IS) or 20 ml (IC) of levobupivacaine 0.5%. The block was defined successful with complete sensory and motor blockade of upper extremity at 20 min post-procedure. Postoperative patient-controlled perineural levobupivacaine infusion plus multimodal analgesia were administered for pain management. The outcomes included pain evaluation using numeric rating scales (0 to 10), opioid requirement, side effects, ward nurses and patients’ satisfaction and technique-related complications within 72 hours were daily evaluated.
Results: Twenty-two patients were included. The success rate of both techniques was 100%. Catheters were maintained 2.82+1.33 days. Within 72 h postoperatively, 95.5 to 100% and 77.3 to 95% of the patients had mild pain (NRS 0 to 3) at rest and on movement respectively. One third (36.4%) of the patients had opioid-free requirement. Most patients (81.8%) were very satisfied with pain management. There were 16 cases (72.7%) noted for technical problems with catheters. Three patients (13.6%) suffered from nausea and vomiting. There was no CBPB-related major adverse event, but one had partly reversible radial and ulnar nerve injury, possibly due to prolonged tourniquet application.
Conclusion: Continuous ultrasound-guided brachial plexus block is effective pain management and few major adverse events in upper extremity surgery.
Keywords: Continuous brachial plexus block (CBPB), Ultrasound guided, Interscalene catheter, Infraclavicular catheter, Perineural infusion