Wrist Fractures treated with Surgeon Delivered Ultrasound Guided Supraclavicular Blocks: Do we Still Need Anesthesiologists for Upper Extremity Surgery?
Calva Daniel, MD, FACS1; Raul A Cortes, MD, FACS1; Roger K. Khouri, MD2
1Miami Breast Center, Miami, FL; 2Miami Hand Center, Miami, FL
Introduction Anesthesiologists require preoperative testing for wrist fractures. They tend to delay care, increase costs and slow the daily flow of surgical patients. Familiar with ultrasound and anatomy, surgeons are well poised to deliver ultrasound guided supraclavicular blocks (UGSB.) We reviewed our experience with surgeon delivered UGSB without anesthesiologists to assess its safety and efficacy.
Methods We retrospectively reviewed all DRFs ORIF performed at our ASC by 3 surgeons over a 6-year period. Operative data, complications, demographics, clinical characteristics, fracture patterns, and functional outcomes were evaluated.
Results 2,035 consecutive patients underwent ORIF without anesthesiologists; 1,301 females, 734 males, age 62years (27-97). Four bilateral fractures. AO Fracture types: 760(A), 501(B) and 774(C); with 7 Gustilo(I), 2 Gustilo(II), and 68 malunions. Twenty-two distal ulnar fractures also required ORIF. 1,675 patients were ASA2, and 360 ASA3. Average time to administer block was 5.5min, tourniquet time 24.5min, and 63min total time patient spent in facility. Patients received no IVís, self-ambulated to and from the OR table pain free, and conversed with the sitter nurse thru the procedure. 72 patients had partial UGSB failure requiring local lidocaine supplementation. No block related complications occurred except one transient unilateral phrenic nerve palsy. There were no infections, no hematomas and postoperatively required only 15 narcotic pills on the average (50% of historical). Upon discharge, 1,901 patients achieved normal range-of-motion, and 4 developed CRPS. Patient easily tolerated surgery without anesthesiologists and were highly satisfied with the expedited care and outcome.
Conclusions ORIF of DRFs can be safely, expeditiously, successfully, and cost-effectively treated by surgeon delivered UGSB without anesthesiologists and extensive preoperative testing.
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