This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Guntz, E. Articles by Sosnowski, M. Search for Related Content PubMed PubMed Citation Articles by Guntz, E. Articles by Sosnowski, M.

The radial nerve should be blocked before the ulnar nerve during a brachial plexus block at the humeral canal

[Le nerf radial doit être anesthésié avant le nerf cubital pendant un blocage du plexus brachial au travers du canal huméral]

Emmanuel Guntz, MD^*, Pierre Herman, MD^*, Alain Delbos, MD and Maurice Sosnowski, MD PhD^*

^* From the Department of Anesthesiology, Université Libre de Bruxelles, Hôpital Universitaire Saint-Pierre, Brussels, Belgium; and
Clinique des Cêdres, Toulouse, France.

Address correspondence to: Dr. Emmanuel Guntz, Department of Anesthesiology, C.H.U. Saint-Pierre, rue Haute, 322, Brussels 1000, Belgium. Phone : 003225353593; Fax: 003225354070; E-mail: eguntz{at}ulb.ac.be

Purpose: The brachial plexus block through the humeral canal as described by Dupré is indicated in hand and forearm surgery. This block requires a multi-stimulation technique that emphasizes the necessity of a rigorous and safe technique. Nerve injury associated with regional anesthesia can entail significant morbidity for patients. Thus, we investigated the brachial block sequence in terms of unintended nerve stimulation as a surrogate of potential nerve injury.

Methods: Sixty patients were randomly allocated in two groups of 30. In Group I the radial nerve was blocked before the ulnar nerve. In Group II the ulnar nerve was blocked before the radial nerve. During the radial nerve approach we recorded, if present, an ulnar nerve response. During the ulnar nerve approach we recorded, if present, a radial nerve response.

Results: In Group I while looking for the radial nerve, in 50% of the cases, an ulnar motor response was recorded. In Group II while looking for the ulnar nerve, a radial motor response was recorded in 10% of the cases.

Conclusion: Our results indicate that the radial nerve should be blocked before the ulnar nerve when performing a brachial plexus block at the humeral canal.

This article has been cited by other articles:

				Q. H. De Tran, A. Clemente, J. Doan, and R. J. Finlayson Brachial plexus blocks: a review of approaches and techniques: [Les blocs du plexus brachial : compte-rendu des approches et techniques] Can J Anesth, August 1, 2007; 54(8): 662 - 674. [Abstract] [Full Text] [PDF]