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Nerve Stimulator Guided Axillary Block in Painless Reduction of Distal Radius Fractures; a Randomized Clinical Trial

Hossein Alimohammadi, Majid Shojaee, Mehdi Samiei, Somayeh Abyari, Ali Vafaee, Alireza Mirkheshti



Introduction: Given the high prevalence of upper extremity fractures and increasing need to perform painless reduction in the emergency departments, the use of analgesic methods with fewer complications and more satisfaction appears to be essential. The aim of this study is comparison the nerve stimulator guided axillary block (NSAB) with intravenous sedation in induction of analgesia for painless reduction of distal radius fractures. Methods: In the present randomized clinical trial, 60 patients (18-70 years of age) suffered from distal radius fractures, were divided into two equal groups. One group received axillary nerve block by nerve stimulator guidance and the other procedural sedation and analgesia (PSA) using midazolam/fentanyl. Onset of analgesia, duration of analgesic effect, total procedure time and pain scores were recorded using visual analogue scale (VAS) and the outcomes were compared. Chi-squared and student t test were performed to evaluate differences between two groups. Results: Sixty patients were randomly divided into two groups (83.3% male). The mean age of patients was 31 ±0.7 years. While the onset of analgesia was significantly longer in the NSAB group, the mean total time of procedure was shorter than PSA (p<0.001). The NSAB group needed a shorter post-operative observation time (P<0.001). Both groups experienced equal pain relief before, during and after procedure (p>0.05). Conclusion: It seems that shorter post-operative monitoring time and consequently lesser total time of procedure, make nerve stimulator guided axillary block as an appropriate alternative for procedural sedation and analgesia in painless reduction of distal radius fractures in emergency department.



Nerve block; nerve stimulator; procedural sedation and analgesia; radius fracture


Grant CR, Checketts MR. Analgesia for primary hip and knee arthroplasty: the role of regional anaesthesia. crit Care Pain. 2008;8(2):56-61.

Ootes D, Lambers KT, Ring DC. The epidemiology of upper extremity injuries presenting to the emergency department in the United States. Hand. 2012;7(1):18-22.

Stone MB, Wang R, Price DD. Ultrasound-guided supraclavi- cular brachial plexus nerve block vs procedural sedation for the treatment of upper extremity emergencies. Am J Emerg Med. 2008;26(6):706-10.

Alimohammadi H, Azizi M-R, Afshin A, Safari S, Kariman H, Hatamabadi H. Axillary Nerve Block in Comparison with Intravenous Midazolam/Fentanyl for Painless Reduction of Upper Extremity Fractures. Acta Med Iran. 2013;[In press].

Olch PD. William S. Halsted and local anesthesia: contributions and complications. Anesthesiology. 1975;42(4): 479-86.

Sia S, Lepri A, Marchi M. Axillary block by "selective" injections at the nerves involved in surgery using a peripheral nerve stimulator: a comparison with a "standard" triple-injection technique. Reg Anesth Pain Med. 2010;35(1):22-7.

Turkan H, Baykal B, Özisik T. Axillary brachial plexus blockade: an evaluation of three techniques. Mil Med. 2002; 167(9):723-5.

Rothe C, Asghar S, Andersen H, Christensen J, Lange K. Ultrasound‐guided block of the axillary nerve: a volunteer study of a new method. Acta Anaesthesiol Scand. 2011;55 (5):565-70.

Lee SM, Park S-E, Nam Y-S, et al. Analgesic effectiveness of nerve block in shoulder arthroscopy: comparison between interscalene, suprascapular and axillary nerve blocks. Knee Surg Sports Traumatol Arthrosc. 2012;20(12):2573-8.

Todd KH, Funk KG, Funk JP, Bonacci R. Clinical significance of reported changes in pain severity. Ann Emerg Med. 1996;27(4):485-9.

Cramer KE, Glasson S, Mencio G, Green NE. Reduction of forearm fractures in children using axillary block anesthesia. J Orthop Trauma. 1995;9(5):407-10.

Wedel DJ, Krohn JS, Hall JA. Brachial Plexus Anesthesia in Pediatric Patients. Mayo Clinic proceedings Mayo Clinic. 1991; 66(6):583-8.

Kriwanek KL, Wan J, Beaty JH, Pershad J. Axillary block for analgesia during manipulation of forearm fractures in the pediatric emergency department a prospective randomized comparative trial. J Pediatr Orthoped. 2006;26(6):737-40.

Stone MB, Price DD, Wang R. Ultrasound-guided supraclavicular block for the treatment of upper extremity fractures, dislocations. Am J Emerg Med. 2007;25(4):472-5.

Stan TC, Krantz MA, Solomon DL, Poulos JG, Chaouki K. The incidence of neurovascular complications following axillary brachial plexus block using a transarterial approach: a prospective study of 1,000 consecutive patients. Reg Anesth Pain Med. 1995;20(6):486-92.

Ben-David B, Stahl S. Axillary block complicated by hematoma and radial nerve injury. Reg Anesth Pain Med. 1999;24(3):264-6.

DOI: https://doi.org/10.22037/emergency.v1i1.5281


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