Observation of analgesic effect of ultrasound-guided brachial plexus combined with intercostal brachial nerve block in the operation of distal humeral fracture

doi:10.3969/j.issn.1674-8115.2022.05.010

Abstract

Abstract: Objective

·To investigate the analgesic effect of ultrasound-guided intercostobrachial nerve (ICBN) block on patients with distal humeral fracture who need surgical treatment through posterior approach.

Methods

·One hundred and forty-nine patients with distal humeral fracture were enrolled in Shanghai Sixth People's Hospital from February 2016 to March 2021. They underwent elective surgery via posterior approach under non-general anesthesia and were selected for retrospective analysis. They were divided into two groups according to the way of nerve block: 107 cases of brachial plexus block (BP group), and 42 cases of brachial plexus combined with ICBN block (ICB group). The ICB group was divided into two subgroups according to different approaches of ICBN block: 17 cases in “under pectoralis minor” group (ICB1 group) and 25 cases in “axillary region” group (ICB2 group). The general condition of the four groups, the intraoperative sufentanil dosage, visual analogue scale (VAS) pain score, sedation rate and other analgesic demand rates were analyzed.

Results

·There was no significant difference in age, sex, ASA classification, BMI, operation time and bleeding volume between the BP group and ICB group (P>0.05). There was also no significant difference in these general features between the ICB1 group and ICB2 group (P>0.05). The usage of sufentanil, VAS score, sedation rate and other analgesic drug demand rates in the ICB group were lower than those in the BP group (P=0.001, P=0.000, P=0.012, P=0.018), which was statistically significant. There was no significant difference in aspects mentioned above between the two subgroups (P>0.05).

Conclusion

·Compared with brachial plexus block alone, ICBN block combined with brachial plexus block can significantly enhance the analgesic effect in the operation of distal humeral fracture through posterior approach, and the analgesic effect of the two ICBN block techniques is similar.

Key words: intercostobrachial nerve block, brachial plexus block, distal humerus fracture, analgesia

CLC Number:

R614.4

CHEN Moxi, XU Tao, GAO Xiaoyun, WANG Wenying, CHEN Yongzhu. Observation of analgesic effect of ultrasound-guided brachial plexus combined with intercostal brachial nerve block in the operation of distal humeral fracture[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(5): 624-628.

Figures/Tables 4

TrendMD

References 12

1	ROBINSON C M, HILL R M, JACOBS N, et al. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment[J]. J Orthop Trauma, 2003, 17(1): 38-47.
2	MCKEE M D, WILSON T L, WINSTON L, et al. Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach[J]. J Bone Joint Surg Am, 2000, 82(12): 1701-1707.
3	HENRY B M, GRAVES M J, PĘKALA J R, et al. Origin, branching, and communications of the intercostobrachial nerve: a meta-analysis with implications for mastectomy and axillary lymph node dissection in breast cancer[J]. Cureus, 2017, 9(3): e1101.
4	王爱忠, 范坤, 赵达强. 超声引导下的神经阻滞技术[M].上海: 上海交通大学出版社, 2019: 71.
	WANG A Z, FAN K, ZHAO D Q. Ultrasound-guided nerve block technique[M]. Shanghai: Shanghai Jiao Tong University Press, 2019:71.
5	PURCELL N, WU D. Novel use of the PECS Ⅱ block for upper limb fistula surgery[J]. Anaesthesia, 2014, 69(11): 1294.
6	QUEK K H, LOW E Y, TAN Y R, et al. Adding a PECS Ⅱ block for proximal arm arteriovenous access: a randomised study[J]. Acta Anaesthesiol Scand, 2018, 62(5): 677-686.
7	SHAH S, MATHKAR S. Ultrasound-guided multiple peripheral nerve blocks, a way out for anesthesia in morbidly obese patients for bone marrow aspiration[J]. Braz J Anesthesiol, 2020, 70(3): 295-298.
8	THALLAJ A K, AL H M K, ALZAHRANI T A, et al. Ultrasound imaging accurately identifies the intercostobrachial nerve[J]. Saudi Med J, 2015, 36(10): 1241-1244.
9	MAGAZZENI P, JOCHUM D, IOHOM G, et al. Ultrasound-guided selective versus conventional block of the medial brachial cutaneous and the intercostobrachial nerves: a randomized clinical trial[J]. Reg Anesth Pain Med, 2018, 43(8): 832-837.
10	VARELA V M, RUIZ C A, MONTECINOS S, et al. Ultrasound-guided selective block of the medial brachial cutaneous and the intercostobrachial nerves for proximal arteriovenous fistula surgery[J]. Reg Anesth Pain Med, 2019. DOI:10.1136/rapm-2018-100298.
11	WIJAYASINGHE N, DURIAUD H M, KEHLET H, et al. Ultrasound guided intercostobrachial nerve blockade in patients with persistent pain after breast cancer surgery: a pilot study[J]. Pain Physician, 2016, 19(2): E309-E318.
12	YAMAK A E, GALLUCCIO F, SALAZAR C, et al. New approach for blocking intercostobrachial and medial brachial cutaneous nerve in the axillary area: response to Varela[J]. Reg Anesth Pain Med, 2020, 45(10): 841-842.

Item	BP group （n=107）	ICB group （n=42）	P value
Age/year	46.13±16.89	51.81±16.47	0.848
Gender/n （%）			0.119
Male	51 （47.7）	26 （61.9）
Female	56 （52.3）	16 （38.1）
ASA classification/n （%）			0.194
Ⅰ	51 （47.7）	25 （59.5）
Ⅱ	56 （52.3）	17 （40.5）
BMI/（kg·m^-2）	24.02±2.96	25.17±3.93	0.190
Operation duration/min	142.81±51.37	127.36±49.62	0.121
Bleeding volume/mL	318.22±116.25	273.81±131.70	0.060

Item	BP group （n=107）	ICB group （n=42）	P value
Age/year	46.13±16.89	51.81±16.47	0.848
Gender/n （%）			0.119
Male	51 （47.7）	26 （61.9）
Female	56 （52.3）	16 （38.1）
ASA classification/n （%）			0.194
Ⅰ	51 （47.7）	25 （59.5）
Ⅱ	56 （52.3）	17 （40.5）
BMI/（kg·m^-2）	24.02±2.96	25.17±3.93	0.190
Operation duration/min	142.81±51.37	127.36±49.62	0.121
Bleeding volume/mL	318.22±116.25	273.81±131.70	0.060

Item	ICB1 group （n=17）	ICB2 group （n=25）	P value
Age/year	50.35±17.26	52.80±16.19	0.710
Gender/n （%）			0.345
Male	12 （70.6）	14 （56.0）
Female	5 （29.4）	11 （44.0）
ASA classification/n （%）			0.577
Ⅰ	11 （64.7）	14 （56.0）
Ⅱ	6 （35.3）	11 （44.0）
BMI/（kg·m^-2）	25.41±4.05	25.01±3.91	0.666
Operation duration/min	140.00±50.64	118.76±48.02	0.777
Bleeding volume/mL	250.00±131.10	290.00±132.29	0.336

Item	ICB1 group （n=17）	ICB2 group （n=25）	P value
Age/year	50.35±17.26	52.80±16.19	0.710
Gender/n （%）			0.345
Male	12 （70.6）	14 （56.0）
Female	5 （29.4）	11 （44.0）
ASA classification/n （%）			0.577
Ⅰ	11 （64.7）	14 （56.0）
Ⅱ	6 （35.3）	11 （44.0）
BMI/（kg·m^-2）	25.41±4.05	25.01±3.91	0.666
Operation duration/min	140.00±50.64	118.76±48.02	0.777
Bleeding volume/mL	250.00±131.10	290.00±132.29	0.336

Item	BP group（n=107）	ICB group（n=42）	P value
Usage of sufentanil/µg	4.29±4.89	1.52±2.17	0.001
VAS score	2 （1， 2）	1 （1， 2）	0.000
Sedation/n （%）	91 （85.1）	28 （66.7）	0.012
Demand of other analgesic drugs/n （%）	26 （24.3）	3 （7.1）	0.018