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East African Medical Journal

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Brachial Plexus Blocks for Upper Extremity Surgeries in a Nigerian Hospital

A Rukewe, A Fatiregun, OPA Arikawe, TO Alonge

Abstract


Background: Different techniques of brachial plexus blocks are in use to provide surgical anaesthesia from the shoulder to the fingertips. However, they are perceived as time-consuming and unreliable as the sole anaesthetic for surgical procedures. Until recently (July 2008), only general anaesthesia was employed in our centre even for hand surgeries.
Objective: To evaluate the use and outcome of brachial plexus blocks for upper extremity surgeries.
Design: A retrospective review of patients’ records and prospective observation of patients with upper extremity surgeries.
Setting: The University College Hospital, Ibadan, situated in Southwestern Nigeria with over 875 beds.
Subjects: Patients who had surgeries of the shoulder, humerus, elbow, forearm, wrist and hand were studied.
Results: In 2006 and 2007, only general anaesthetic accounted for the 220 upper extremity surgeries. However, in 2008, 2009 and 2010, brachial plexus blocks accounted for 6.9, 27.9 and 48.6% respectively. From a success rate of 60.0% in the first year of practicing brachial plexus anaesthesia using 40% paraesthesia technique, the second and third years were 78.9 and 96.5% respectively due to better localisation techniques (nerve stimulation alone or in combination with echo-guidance).
Conclusion: Our study shows an increasing successful use of brachial plexus block techniques for upper extremity procedures.



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