Ultrasound-guided axillary brachial plexus block versus distal peripheral forearm nerve block for hand and wrist surgery: a randomised controlled trial

Editor—Regional anaesthesia and local anaesthesia are increasingly recognised as the best options to provide anaesthesia for ambulatory hand and wrist surgery. 1 Teunkens A. Vermeulen K. Belmans A. Degreef I. Van de Velde M. Rex S. Patient satisfaction with intravenous regional anaesthesia or an axillary block for minor ambulatory hand surgery: a randomised controlled study. Eur J Anaesthesiol. 2020; 37: 847-856 Crossref PubMed Scopus (6) Google Scholar Ultrasound (US)-guided axillary brachial plexus block is one of the preferred techniques of most anaesthesiologists for distal upper extremity surgery. 2 Neal J.M. Gerancher J.C. Hebl J.R. et al. Upper extremity regional anesthesia: essentials of our current understanding, 2008. Reg Anesth Pain Med. 2009; 34: 134-170 Crossref PubMed Scopus (244) Google Scholar Disadvantages of this technique include the risk of arterial puncture and slower onset compared with i.v. regional anaesthesia. 1 Teunkens A. Vermeulen K. Belmans A. Degreef I. Van de Velde M. Rex S. Patient satisfaction with intravenous regional anaesthesia or an axillary block for minor ambulatory hand surgery: a randomised controlled study. Eur J Anaesthesiol. 2020; 37: 847-856 Crossref PubMed Scopus (6) Google Scholar In recent years, a growing body of literature has investigated the potential of US-guided distal nerve blocks as a primary anaesthetic technique. 3 Jalil H. Polfliet F. Nijs K. et al. Efficacy of ultrasound-guided forearm nerve block versus forearm intravenous regional anaesthesia in patients undergoing carpal tunnel release: a randomized controlled trial. PLoS One. 2021; 16e0246863 Crossref Scopus (7) Google Scholar ,4 Soberón J.R. Bhatt N.R. Nossaman B.D. Duncan S.F. Patterson M.E. Sisco-Wise L.E. Distal peripheral nerve blockade for patients undergoing hand surgery: a pilot study. Hand (N Y). 2015; 10: 197-204 Crossref PubMed Scopus (9) Google Scholar The main advantage of distal peripheral forearm nerve blocks is the preservation of motor function of the digits and the more proximal muscles. 5 Sehmbi H. Madjdpour C. Shah U.J. Chin K.J. Ultrasound guided distal peripheral nerve block of the upper limb: a technical review. J Anaesthesiol Clin Pharmacol. 2015; 31: 296-307 Crossref PubMed Scopus (27) Google Scholar Because of the large number of short procedures performed within the field of hand surgery, rapid turnover with reliable regional anaesthesia is required for optimal efficiency. However, block performance time and total anaesthesia-related time, focused on regional anaesthesia for hand surgery, have not been studied in an RCT. This observer-blinded, randomised controlled superiority trial was designed to compare US-guided axillary brachial plexus block and distal peripheral forearm nerve block in patients undergoing hand surgery and carpal tunnel release.