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Radial or Brachial Artery Injections for Intraarterial Regional Anesthesia for Hand Surgery?
  1. Z. J. Koscielniak-Nielsen, M.D., F.R.C.A. and
  2. A. Horn, M.D., D.E.A.A.
  1. From the Department of Anesthesia, National University Hospital, Rigshospitalet, Copenhagen, Denmark
  1. Reprint requests: Dr. Zbigniew J. K. Nielsen, Department of Anesthesia, 2034 Rigshospitalet, 2100 Copenhagen Ø, Denmark.


Background and Objectives The aim of this study was to determine the optimal injection site for the intraarterial regional anesthesia for hand surgery.

Methods Forty-two adult patients undergoing elective hand surgery were studied. 0.5% lidocaine plain 1.5 mg/kg was injected over 3 minutes into the radial artery (group 1), or the brachial artery (group 2) through a 22 or 20 gauge Teflon catheter.

Results Two patients (one in each group) were excluded due to technical problems. Onset of analgesia in the hand was faster after radial artery injection (P < .05). Onset of analgesia in the forearm was similar in both groups. Catheterization time, operating conditions, motor block, offset of analgesia, injection, surgical and tourniquet pain scores, and patient’s acceptance were similar. Ten patients in group 1 and nine patients in group 2 needed supplemental analgesia at the start of surgery. Median nerve paresthesias were unintentionally elicited during catheterization in three patients in group 2. Six patients (two in group 1 and four in group 2) had minor systemic adverse effects after tourniquet release. Seven patients in group 1 and five in group 2 developed minor bruises after catheterization. No permanent sequelae of injections were observed.

Conclusions Radial artery is preferred for intraarterial regional anesthesia. Compared with the brachial artery, injection in the radial artery produces faster analgesia in the hand and reduces the risk of damage to the median nerve.

  • anesthetic techniques
  • regional
  • intraarterial
  • intravenous
  • local
  • lidocaine

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  • This study was conducted entirely at Rigshospitalet, Copenhagen, Denmark, and not supported by any grants.

    Presented at the XIII Annual European Society of Regional Anesthesia Meeting, Barcelona, May 1994.