Transarterial brachial plexus anesthesia for hand surgery: a retrospective analysis of 346 cases

STUDY OBJECTIVES: To study the safety and efficacy of the transarterial approach to brachial plexus block with 60 to 70 ml of local anesthetic solution, and to compare the success and complication rates of this block performed by experienced or inexperienced anesthesiologists. DESIGN: Retrospective analysis of 346 records of ASA physical status I-IV patients who underwent elective unilateral orthopedic upper limb surgery with transarterial plexus anesthesia. SETTING: University teaching hospital. MEASUREMENTS AND MAIN RESULTS: Blood pressure (BP) and heart rate were measured at 5-minute intervals. Analgesia was registered as successful, incomplete, or failed. Any patient complaints or adverse reactions were recorded. The first 60 ml of local anesthetic provided surgical analgesia to 64% of patients. With a supplemental 10 ml of anesthetic, the overall success rate was 94%, with only 19 of 346 patients requiring general anesthesia. Experience in performing the block increased the success rate from 90% to 98% (p < 0.001). Six patients experienced either nausea or a transient BP decrease that did not require medication. There was no record of toxic or other serious adverse reaction. CONCLUSIONS: Transarterial brachial plexus block administered with a 60 to 70 ml dose of local anesthetic provides surgical analgesia for hand surgery with an excellent success rate and without serious adverse effects.