TOURNIQUET PAIN DURING UPPER LIMB SURGERY UNDER ULTRASOUND-GUIDED AXILLARY BRACHIAL PLEXUS BLOCK.
Author(s):
M. Narayanan1, A. Soodan2, I. Ahmad3
Institute(s):
1Department of Anaesthesia, Kings College Hospital, 2Department of Anaesthesia, Lewisham hospital, 3Department of Anaesthesia, Guy\'s & St Thomas\' NHS Foundation Trust, London, UK
Text:
Background and aims: One of the limitations of using a tourniquet in awake patients is the development of tourniquet pain. Blocking the musculocutaneous and radial nerves has been advocated to decrease the incidence of tourniquet pain during surgery under axillary brachial plexus blocks. We report the incidence of tourniquet pain in awake patients have upper limb surgery under ultrasound guided axillary brachial plexus block.
Methods: Over a period of nine months, eighty-six patients were included in the audit who under-went upper limb surgery under ultrasound guided axillary brachial plexus block. We blocked the musculocutaneous, median, ulnar, radial nerves and medial cutaneous nerve of the arm in all these patients. All patients stayed awake and were not given any sedation. A pneumatic tourniquet was used and the pressure of the tourniquet was maintained at 250 mm of Hg. The tourniquet times, incidence of any tourniquet pain or discomfort was recorded. And the measures taken to relieve the tourniquet pain or discomfort were also recorded.
Results: The tourniquet times varied from 5 to 169 minutes (mean 50.9). Tourniquet pain was reported in 1 patient and tourniquet had to be deflated a few minutes earlier and mild discomfort was reported in 2 patients who did not need any sedation or analgesia for the discomfort.
Conclusions: The effective block of the musculocutaneous, radial and medial cutaneous nerve of the arm during ultrasound guided axillary brachial plexus blocks decreases the incidence of tourniquet pain.
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