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Ultrasound-guided forearm selective nerve block: A bright future on the horizon

Ziwei Xia1,2, Guangkuo Ma1,2, Huanjia Xue1,2, Hui Wu1,2, Liwei Wang1,2, Kai Wang1,2


1Graduate School, Xuzhou Medical University, Xuzhou 221009, Jiangsu Province, China. 2Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou 221009, Jiangsu Province, China.


Address correspondence to: Kai Wang, Department of Anesthesiology, Xuzhou Central Hospital, No. 199 Jiefang South Road, Quanshan District, Xuzhou 221009, Jiangsu Province, China. Tel: +86-18112012729; E-mail: wangkaistream99@sina.com or 760020230115@xzhmu.edu.cn.


Acknowledgement: This work was supported by the Department of Anesthesiology of Xuzhou Central Hospital. The authors would like to thank all the guest editors and anonymous reviewers for their constructive comments.


DOI: https://doi.org/10.61189/768941essmpc


Received January 25, 2024; Accepted April 2, 2024; Published September 30, 2024


Highlights

● In the realm of forearm, wrist, and hand surgeries, ultrasound-guided forearm selective nerve block techniques offer distinct advantages over alternative methods such as Bier's block, brachial plexus block, and wrist block. These advantages include reduced anesthesia-related time, prolonged duration of analgesia, and minimal inter-ference with upper extremity motor function. 

● Ultrasound-guided forearm selective nerve block stands as a straightforward and conducive anesthesia method ideally suited for distal upper limb surgeries. This approach harmonizes seamlessly with the principles of fast surgical recovery and enhances patient comfort during both diagnostic and therapeutic procedures. 

● Supplementation of dexmedetomidine or dexamethasone in ultrasound-guided selective nerve blocks of the forearm has been shown to significantly prolong the duration of analgesia.

Abstract

Objective: In light of the advancement of modern medicine, anesthesiologists and surgeons are increasingly prioritizing patient comfort in diagnostic and therapeutic procedures. A growing body of research revolves around the  utilization of ultrasound-guided forearm selective nerve blocks for surgeries involving the distal upper limb. This review aims to provide an overview of regional anesthesia techniques in forearm, hand, and wrist surgeries, laying a theoretical foundation for the prospects of ultrasound-guided forearm selective nerve blocks in optimizing comfort during diagnostic and therapeutic procedures. Methods: A retrospective review of literature sourced from the PubMed database was conducted to comprehensively evaluate and elucidate the advantages and drawbacks of ultrasound-guided forearm selective nerve blocks, brachial plexus blocks, Bier blocks, and wrist blocks. Additionally, a summary was provided regarding the selection of local anesthetics for ultrasound-guided forearm selective nerve blocks. Results: Overall, ultrasound-guided forearm selective nerve block techniques exhibit several advantages over Bier's block, brachial plexus block, and wrist block for the majority of forearm, wrist, and hand surgeries. These advantages include reduced anesthesia-related time, prolonged duration of analgesia, and minimal impairment of upper extremity motor function. Consequently, these techniques enhance surgical safety and facilitate  postoperative recovery. Furthermore, the addition of dexmedetomidine or dexamethasone to ultrasound-guided selective nerve blocks of the forearm could extend the duration of analgesia. Conclusion: Ultrasound-guided forearm selective nerve block is a straightforward and conducive anesthesia method for distal upper limb surgeries, aligning with the principles of fast surgical recovery and enhanced patient comfort during diagnostic and therapeutic procedures. Given its manifold benefits, widespread promotion and adoption of this technique in clinical  practice are warranted.

Keywords: Ultrasound, distal peripheral forearm block, brachial plexus block, dexmedetomidine, dexamethasone

Ziwei Xia, Guangkuo Ma, Huanjia Xue, et al. Ultrasound-guided forearm selective nerve block: A bright future on the horizon. Perioper Precis Med. 2024 Sep; 2(3): 90-98. doi: 10.61189/768941essmpc

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