Comparative study among four nerve localizing methods for wrist block

Objective OF The work: Comparative study between four nerve localizing methods for performance of wrist block to find out the method of better outcome and lesser side effects. Patients and methods: This randomized study was conducted on 160 adult co-operative patients of both sexes class I and II according to the American Society of Anesthesiologists (ASA) Physical Status classification system who were scheduled for hand surgeries under wrist block. These patients were divided into four equal groups according to used method for nerve localization, the first group was paresthesia group (P group), the second one was electrical nerve stimulation group (ES group), the third one was ultrasound guided group (US) and the last group was combined ultrasound with electrical stimulation (USES). The following parameters were detected and recorded in each group; the number of attempts for median and ulnar nerve localization, the patient discomfort level, block performance time, the failure rate, the onset of sensory and motor nerve block, postoperative pain intensity at 0 (immediately postoperative), 2, 4, 6, 12, 18 and 24 hours postoperatively, the time in hours to the first request for supplemental systemic analgesia postoperatively and its total consumption in mg/patients ,the incidence of the associated side effects as postoperative neuropathy, puncture of blood vessels and local anesthetic systemic toxicity and the hemodynamic changes.