Evaluation of the Incidence of Paresthesia in Patients Having Upper Extremity Surgery and Being Performed Peripheral Nerve Block

Abstract

Objectives: With the widespread use of ultrasonography, peripheral nerve blocks are used as an effective anesthesia technique in most surgical procedures. We aimed to evaluate the incidence of paresthesia in brachial plexus blockade performed at different levels. Materials and Methods: Patients who underwent peripheral nerve block for upper extremity surgery in Ibni Sina Hospital Orthopedics Operating Room were included in this study. Demographic data of the patients, type and duration of operation, type of brachial plexus block, local anesthetic dose, sedation and additional anesthetic requirement were recorded from patients’ files. The presence of sensory or motor deficits lasting more than 6 months in the postoperative period was defined as prolonged paresthesia. Results: Our study included 205 patients who underwent upper extremity surgery. Of these patients, 50% (n=102) had hand surgery, 25% (n=51) had forearm surgery, and 25% (n=51) had shoulder surgery. Supraclavicular blockade was performed in 44.4% (n=91), axillary blockade in 29.8% (n=61), and interscalene blockade in 25.6% (n=53). The mean age of the patients was 44.44±16.73 years. 52.2% (n=107) were male and 47.8% (n=98) were female. The incidence of paresthesia was 36.1% (n=74). Among the patients, 30.2% (n=62) reported numbness, 25.4% (n=52) reported tingling, 4.4% (n=9) reported abnormal sensation, 16.6% (n=34) reported pain, and 23.9% reported weakness. There was no statistically significant difference between patients with and without paresthesia in terms of demographic data, type of blockade, sedation, duration of surgery, and amount of local anesthesia (p>0.05). 52.7% (n=39) of patients had paresthesia for 6 months or less, 47.3% (n=35) had paresthesia longer than 6 months. Although not statistically significant, paresthesia lasting longer than 6 months was more common in the supraclavicular blockade group (p>0.05). Conclusion: The incidence of paresthesia is high in upper extremity peripheral nerve block and many undetermined risk factors may be effective. Therefore, a detailed preoperative evaluation should be performed when selecting patients.

Keywords

• Paresthesia
• Upper Extremity
• Brachial Plexus
• Nerve Blockade

Üst Ekstremite Cerrahisi Geçiren ve Periferik Sinir Bloğu Uygulanan Hastalarda Parestezi İnsidansının Değerlendirilmesi

Abstract

Amaç: Ultrasonografi kullanımının yaygınlaşması ile periferik sinir blokları çoğu cerrahi prosedürde etkin bir anestezi tekniği olarak kullanılmaktadır. Bu çalışmada farklı seviyelerde gerçekleştirilen brakiyal pleksus blokajı uygulamalarındaki (supraklaviküler, aksiller ve interskalen) parestezi insidansının değerlendirilmesi amaçlandı. Gereç ve Yöntem: İbni Sina Hastanesi Ortopedi Ameliyathanesi’nde üst ekstremite cerrahisi için periferik sinir bloğu yapılan hastalar çalışmaya dahil edildi. Hastaların demografik verileri, operasyon tipi ve süresi, brakiyal pleksus bloğu tipi, lokal anestezik dozu, sedasyon ve ek anestezi gereksinimleri hasta kayıtlarından kaydedildi. Postoperatif dönemde 6 aydan uzun süren duyusal veya motor defisit varlığı uzamış parestezi olarak tanımlandı. Bulgular: Çalışmamıza üst ekstremite cerrahisi geçiren 205 hasta dahil edildi. Bu hastaların %50’si (n=102) el cerrahisi, %25’i (n=51) ön kol ve %25’i (n=51) omuz cerrahisi geçirmişlerdi. Hastaların %44,4’üne (n=91) supraklaviküler blokaj, %29,8’ine (n=61) aksiller blokaj ve %25,6’sına (n=53) interskalen blokaj uygulanmıştı. Hastaların yaş ortalaması 44,44±16,73 idi. %52,2’si (n=107) erkek, %47,8’i (n=98) kadındı. Parestezi insidansı %36,1 (n=74) idi. Hastaların %30,2’si (n=62) uyuşukluk, %25,4’ü (n=52) karıncalanma, %4,4’ü (n=9) normal olmayan his, %16,6’sı (n=34) ağrı ve %23,9’u güçsüzlük bildirdi. Parestezi görülen ve görülmeyen hastalar arasında demografik veriler, uygulanan blokaj türü, sedasyon uygulanması, ameliyat süresi, lokal anestezi miktarları yönünden istatistiksel olarak anlamlı farklılık yoktu (p>0,05). Parestezisi olan hastaların %52,7’sinde (n=39) 6 ay veya daha kısa süre parestezi, %47,3’ünde (n=35) 6 aydan uzun süre parestezi vardı. İstatistiksel olarak anlamlı olmasa da 6 aydan uzun süren parestezi supraklaviküler blok grubunda daha sıktı (p>0,05). Sonuç: Üst ekstremite periferik sinir bloğunda parestezi insidansı yüksektir ve belirlenmemiş birçok risk faktörü etkili olabilir. Bu nedenle hasta seçimi yapılırken detaylı bir preoperatif değerlendirme yapılmalıdır.

Keywords

• Parestezi
• Üst Ekstremite
• Brakiyal Pleksus
• Sinir Blokajı

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