THE USE OF A SELECTIVE AXILLARY NERVE BLOCK FOR OUTPATIENT HAND SURGERY

Although no guidelines concerning discharge criteria after axillary pl exus block are available, many institutions consider recovery of motor function as a critical factor. With the midhumeral approach, the four main nerves of the upper extremity can be blocked separately using a peripheral nerve stimulator. The aim of this double-blind study was to block the radial (R) and musculocutaneous (MC) nerves with lidocaine, and the median (M) and ulnar (U) nerves with bupivacaine to recover m otor function of the elbow and wrist more rapidly while maintaining lo ng-lasting postoperative analgesia at the operative site. Patients und ergoing surgery for Dupuytren's contracture were randomized into two g roups in a double-blind fashion: in the control group (n = 17), each o f the four nerves was infiltrated with 10 mi, of a mixture of 2% lidoc aine and 0.5% bupivacaine, whereas in the selective group (n = 17), th e R and MC nerves were blocked with 10 mi, of 2% lidocaine each and th e M and U nerves were blocked with 10 mi, of 0.5% bupivacaine each. Re covery of motor block was significantly faster in the selective group (231 +/- 91 vs 466 +/- 154 min). However, time to first sensation of p ain was not different between groups (707 +/- 274 vs 706 +/- 291 min). Ln conclusion, this new approach at the midhumeral level enables the anesthesiologist to selectively administer local anesthetics on differ ent nerves. Implications: in outpatients undergoing surgery for Dupuyt ren's contracture, a midhumeral block was used with the musculocutaneo us and radial nerves blocked by lidocaine and the median and ulnar ner ves blocked with bupivacaine. Recovery of motor function and time to d ischarge were shorter compared with patients who received the mixture on all four nerves.