• Lara Gianesello, Vittorio Pavoni, Roberta Coppini, Laura Tadini Buoninsegni, Gabriele Gori, Emanuele Mori, Laura Paparella, and Gaetano Gritti.
• Department of Anesthesia and Intensive Care, Orthopedic and Traumatologic Center, University Hospital Careggi, 50139 Florence, Italy. gianesello.lara@libero.it <gianesello.lara@libero.it>
• J Clin Anesth. 2010 Feb 1; 22 (1): 7-12.

Study ObjectiveTo investigate the comfort and satisfaction of patients with trauma of the upper limb during two different techniques of axillary brachial plexus block, electrical nerve stimulation and fascial pop.DesignRandomized-prospective, observational study.SettingUniversity surgical center.Patients100 ASA physical status I and II patients undergoing surgery for trauma of the hand and forearm.InterventionsPatients received axillary brachial plexus block with a mixture of 0.5% bupivacaine and 2% lidocaine. They were then allocated to one of two groups to receive either electrical nerve stimulation (Group 1, n = 50), or fascial pop technique (Group 2, n = 50) for nerve location.MeasurementsData were collected on patient demographics, surgery, frequency of complications, and sedation required during the block. Discomfort during the block and surgical comfort were quantified by visual analog scale (0-10). Satisfaction was determined by the following scale: very satisfied, satisfied, dissatisfied, and very dissatisfied. Patients also indicated if in the future they would like to receive the same method of anesthesia.Main ResultsNo differences in demographic or surgical data were found. No serious complications were observed. Eighteen Group 1 patients (36%) and none in Group 2 needed sedation during the blocks. Discomfort during the procedures was greater in Group 1 than Group 2 (4.5 +/- 1.2 vs 1.5 +/- 1, P < 0.05), while patients reported good surgical comfort with both techniques (2.4 +/- 2.9 vs 2.2 +/- 2.1, NS). Eighteen patients in Group 1 and 48 patients in Group 2 would accept the same block for future surgery.ConclusionsIn trauma patients, the fascial pop technique is effective, reduces sedation during axillary brachial plexus block, and has a higher patient acceptance rate than the electrical nerve stimulation technique.

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