Arch Hand Microsurg 2019; 24(2): 152-161  
Ultrasound-Guided Axillary Brachial Plexus Block Performed by Orthopedic Surgeon for Distal Radius Fracture Surgery
Doohoon Sun, Chul-Hyung Lee, Cheol-U Kim, Deukhee Jung, Chung-Han An
Department of Orthopedic Surgery, Daejeon Sun Hospital, Daejeon, Korea
Correspondence to: Chul-Hyung Lee
Department of Orthopedic Surgery, Daejeon Sun Hospital, 29 Mokjung-ro, Jung-gu, Daejeon 34811, Korea
TEL: +82-42-220-8860, FAX: +82-42-220-8464, E-mail: mediiron@naver.com
Received: January 21, 2019; Revised: March 31, 2019; Accepted: March 31, 2019; Published online: June 1, 2019.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: The purpose of this study was to evaluate the usefulness of ultrasound-guided axillary brachial plexus block performed by orthopedic surgeon as an anesthetic method for distal radius fracture surgery.
Methods: From October 2017 to October 2018, an ultrasound-guided axillary brachial plexus block was performed on 161 cases of distal radius fracture requiring surgery. The procedure was performed by orthopedic surgeons using solution (20 mL of lidocaine HCl in 2%, 20 mL of ropivacaine in 0.75%, and 10 mL of normal saline in 0.9%). The success rate of the anesthetic procedure, the duration of analgesic effect, and the complications were investigated. If the anesthesia induction failed, additional local anesthetic methods were performed stepwise and reassessment about whether the operation could proceed was made.
Results: Anesthesia was successful in 155 patients and the success rate was 96.3%. The duration of analgesic effect was 6 hours (3-10 hours). In 6 failed cases of anesthesia, local anesthesia was applied to the pain site in the operating room. In 5 cases, the operation was completed without discomfort. In 1 case complaining of pain around fracture site after the local anesthesia, ultrasound-guided radial nerve block was effective in controlling the pain.
Conclusion: In open surgery of distal radius fractures, an ultrasound-guided axillary brachial plexus block performed by orthopedic surgeon allows anesthesia with high success rates. Even if the surgical anesthesia is incomplete, it is expected that the surgery cab be completed safely if the nerve is identified and the stepwise additional local anesthesia method is performed.
Keywords: Distal radius fracture, Orthopedic surgeon, Ultrasound-guided axillary brachial plexus block, Additional anesthesia


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