Surgeon Administered Regional Anaesthetic Blocks For Hand Surgery In Resource Limited Areas
Kigera JWM1 MbChB, MMed (Orth), Schenck R2, MD, FACS Affi liation: 1-Department of Orthopaedics, Makerere University, Kampala, Uganda /Orthopaedic Surgeon, Orthopaedic Rehabilitation Unit, PCEA Kikuyu Hospital, Kikuyu Kenya 2- Department of Plastic Surgery, Rush University, Chicago, Illinois, USA Correspondence to Dr. James W M Kigera,
Introduction: The axillary block was described more than sixty years ago and has since been used in a variety of scenarios. Recently it has been described with the use of ultrasound and nerve stimulators. These facilities are not available in resource limited areas.
Methods: We describe the simple, but effective, perivascular axillary block technique we have used for regional anaesthetic blocks for hand surgery. We also undertook a prospective cohort study of all patients undergoing hand surgery under this regional block technique at Mu-lago Hospital. We abstracted the drug and dosage used, delay in onset of action and duration of action data for each patient. We excluded patients younger than 12 years. All cases with attempted blocks were included.
Results: The success rate of the procedure was 77.8%. The mean delay in onset of action was 20 minutes with an average duration of action of 99 minutes. The commonest drug used was Mepivacaine with a mean dosage of 333.3mg.
Discussion and conclusion: This technique is reliable with a high success rate. It has few complications and can be used in areas without ultrasound or nerve stimulators.