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Scientific Articles   |    
Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic PatientsAAOS Exhibit Selection
Umasuthan Srikumaran, MD1; Benjamin E. Stein, MD1; Eric W. Tan, MD1; Michael T. Freehill, MD1; John H. Wilckens, MD1
1 c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave. #A665, Baltimore, MD 21224-2780. E-mail address for E.P. Henze: ehenze1@jhmi.edu
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Investigation performed at the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Dec 18;95(24):e197 1-13. doi: 10.2106/JBJS.L.01745
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Abstract

Background: 

Over the past twenty-five years, peripheral nerve blocks have become increasingly common for the management of perioperative pain of the upper extremity. Several factors have led to increasing acceptance and use of these peripheral nerve blocks, including a greater awareness and measurement of patient pain and a greater emphasis on decreasing the duration of hospital stays and associated costs.

Methods: 

We present a review of peripheral nerve blocks for procedures involving the upper extremity, including indications, contraindications, anatomy and technique, expected clinical outcomes and the associated levels of evidence, cost-effectiveness, and complications. We reviewed the scientific literature for studies on the effectiveness of peripheral nerve blocks for orthopaedic procedures involving the upper extremity. Particular attention was directed at the most commonly used nerve blocks, the levels of evidence supporting their use, and emerging technologies such as ultrasonographic guidance.

Results: 

Peripheral nerve blocks for upper-extremity procedures improve postoperative pain control and patient satisfaction, can be administered safely, and have a low complication rate. They are also associated with enhanced participation in postoperative rehabilitation, decreased hospital stays, and decreased costs. There are increasingly higher levels of evidence in the literature to support the use of peripheral nerve blocks in a wide variety of orthopaedic procedures ranging from the shoulder to the hand.

Conclusions: 

The use of peripheral nerve blocks in upper-extremity surgery is common. To actively participate with the patient and anesthesiologist to ensure the best possible outcomes, the orthopaedic surgeon must be well informed regarding the benefits and limitations of this modality.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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