Upper Extremity Blocks for Hand Surgeons: A Literature Review of Regional Anaesthesia Techniques, Efficacy, and Safety.

Abstract

Introduction: Regional anaesthesia (RA) techniques have increased in popularity due to evidence of reductions in acute pain, chronic pain, postoperative nausea and vomiting (PONV), and pulmonary complications. While upper extremity blocks (UEBs) have been the subject of several comprehensive reviews, no review to date has synthesised the information on their use in hand surgery. Methods: A search of PUBMED and Cochrane databases was performed to identify the evidence associated with upper extremity blocks. The results of this search and extant literature on UEBs were examined and the relevant information extracted. Results: Supraclavicular block is associated with transient complications such as Horner's syndrome and phrenic nerve palsy, affecting up to 54% and 50% of patients, respectively. The incidence of pneumothorax in supraclavicular blocks is up to 4%. Infraclavicular, interscalene and axillary blocks have a lower rate of all complications, however, each may require a supplementary block at a different anatomical site as each spares significant regions of the upper extremity. Epinephrine in concentrations of 1:100,000-200,000 is safe for use in digital blocks with no association digital gangrene. Current evidence suggests digital blocks are safe and efficacious when appropriately performed. Conclusion: UEBs are safe and may be administered by an anaesthesia provider or an appropriately trained surgeon. The choice of block is contingent on the anatomical location of the surgical procedure, procedure duration, patient preference, patient co-morbidieis, and the surgeon's experience. Most upper extremity surgeries can be performed using RA. Current evidence illustrates outcome benefits for patients, surgeons, and healthcare institutions utilising RA.