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US-Guided Axillary Approach of Brachial Plexus Block for Forearm Fracture
Attila Aydın1, Sedat Bilge2, Veysel Balcı1, Murtaza Kaya3, Erol Erden Ünlüer4, Erdem Çevik5, Meltem Bilge6, Cemile Aydın7
1Altunizade Acibadem Hospital, Emergency Medicine, Istanbul, Turkey
2Gulhane Training and Research Hospital, Department of Emergency Medicine, Ankara, Turkey
3Kütahya Evliya Celebi Education and Research Hospital, Department of Emergency Medicine, Kütahya, Turkey
4İzmir Katip Celebi University, Izmir Ataturk Training and Research Hospital, Department of Emergency Medicine, Izmir, Turkey
5Sultan Abdul Hamid Training and Research Hospital, Department of Emergency Medicine, Ankara, Turkey
6Dışkapı Training and Research Hospital, Anesthesia and Reanimation, Ankara, Turkey
7Etimesgut State Hospital, Internal Medicine, Ankara, Turkey
Keywords: Axillary, forearm, fracture, peripheral nerve block

Background: In Emergency Departments (EDs), procedural sedation analgesia, hematoma block, intravenous regional anaesthesia and peripheral nerve blocks are usually used for pain control in forearm fractures. We aimed to review the results of Visual Analog Scale (VAS) scores (during examination and reduction), post reduction neurovascular examinations and complications of forearm fractures which were applied US-guided axillary approach of brachial plexus block (AABPB).

Patients and Methods: We described fourteen patients, who presented to the ED with forearm fractures, and were reduced using US-guided AABPB performed by emergency physicians. The same technique was used for all fourteen nerve blocks. We reviewed the results of VAS scores (during examination and reduction), post reduction neurovascular examinations and complications of forearm fractures who were applied AABPB.

Results: Of the 14 patients admitted to study, the mean age was 59.92 ±12,81 (36.00 – 82.00). Mean VAS score of patients before procedures was 91.57 ± 3.99 (85,00 – 98.00) mm. The US-guided AABPB was performed by emergency physicians and nerve block fracture was reduced. 20 minutes after reduction, mean VAS score of patients was 10.21 ± 5.36 (0 – 19.00) mm. performed (Table 1). All patients were discharged after approximately eight hours’ observation period and post-reduction neurovascular examinations were normal. There were no complications during block and reduction.

Conclusion: US-guided axillary approach of brachial plexus block is a technique that can be applied easily in the ED by emergency physicians for forearm fractures. In this technique, the procedural success rate is high, and it was noticed a high level of patient and physician satisfaction.