Materials and methods
nerve injury, thumb abduction, infections, pain, diabetes, peripheral vascular disease, allergies
INFILTRATION, INFECTIONS, ALLERGIES
The study was conducted at the Adıyaman University Research and Training Hospital between 01 August 2021 and 15 April 2022.The study included 50 patients between the ages of 18 and 65 years who were in the American Society of Anesthesiologists (ASA) I–II group and were scheduled for upper extremity surgery (hand, wrist, and forearm). Patients with diabetes, peripheral vascular disease, allergies to the local anesthetics (LAs), alpha- or beta-blocker use, local infections at the site of the operation, suspicion of nerve injury found during a neurologic examination prior to surgery, and refusal to participate in the study were excluded from the study.The time of block induction was defined as the infiltration of LA into the perineural area with a needle under ultrasound guidance. Peripheral oxygen saturation, heart rate, non-invasive arterial blood pressure values, and the PI values measured at both upper extremities were recorded in patients before block induction (0 min) and 5, 10, and 20 min after block completion.Asepsis in the infraclavicular region was achieved when the patient was laid in the supine position with their head turned to the opposite side. The median, lateral, and posterior cords of the BP were visualized using a high-frequency linear ultrasound probe around the artery in the infraclavicular area. To perform the USG guided in-plane technique, a 22G 50-mm needle was used. A second confirmation was performed using a nerve stimulator (NS) by applying 0.2–0.8 mA electrical stimulation. After observing the motor response of each chord, perineural LA infiltration was administered to each cord. For this treatment, each patient received 20 mL of 0.5% bupivacaine (Buvicaine 0.5%, 5 mg/mL Polifarma) and 2% lidocaine (Jetmonal 2%, 20 mg/mL, Adeka, Turkey).The sensory onset times of the block in all upper extremity areas, including the axillary nerve (lateral side of the upper arm), musculocutaneous nerve (lateral side of the forearm), radial nerve (dorsal part of hand at the 2nd metacarpophalangeal joint), median nerve (thenar eminence), ulnar nerve (little finger), and cutaneous nerves, were measured every 5 min until 30 min after the last injection (medial side of the upper arm and the medial side of the forearm). Three minutes after the block was induced, the pinprick test was used to assess and record the degree of sensory blockage in the affected arm (0: no sensory block; 1: sensation of touch present, no pain; 2: no sensation of touch, no pain). The PI readings were recorded at this exact time, along with the minute the pinprick test was positive.Every 5 min, until the 30 min, 5 motor nerves were evaluated for the motor block: the musculocutaneous (elbow flexion), radial (thumb abduction), median (third digit flexion), ulnar (fifth digit flexion), and the axillary nerve (arm abduction). The results were then compared with those of the other arm. Three minutes after the block was induced, the degree of motor blockade in the affected arm was measured and recorded every minute using the MBS (0: no block, the patient can lift the arm; 1: motor strength reduced, but the arm can move; 2: the arm is immobile, but the digits can move; 3: complete block, no movement in the arm or hand). The minute the grade reached 3 on the MBS was noted, as well as the PI values at that exact moment.The application of peripheral nerve blocks, the inspection of sensory-motor blocks, and the assessment of PI values were performed by several researchers. Both the patients and researchers were blinded to the examination findings and measured values.