Ultrasound-guided Regional Anesthesia by Hand Surgeon

In Japan, it has long been common practice for hand surgeons to perform regional anesthesia for their own surgical procedures. However, the success of this technique has traditionally been highly dependent on the surgeon's skill. Poor technique could result in inadequate anesthesia or the need for excessive doses of local anesthetic, both of which pose risks to the patient. 

The advent of ultrasound-guided puncture techniques has revolutionized this practice, allowing surgeons to administer precise, effective regional anesthesia with minimal amounts of anesthetic. With a thorough understanding of brachial plexus anatomy, hand surgeons can reliably achieve adequate nerve blocks without complications. 

One significant advancement is the ability to place a catheter adjacent to the targeted peripheral nerve under ultrasound guidance, enabling continuous postoperative pain relief. A two-day continuous nerve block allows for pain-free postoperative rehabilitation of the hand and fingers, improving surgical outcomes. 

Additionally, we will discuss our experience with selective sensory nerve blocks guided by ultrasound. This technique allows surgeons to proceed with procedures such as tendon transfers in the forearm using minimal anesthetic, while maintaining the ability to assess the functional outcomes of the surgery intraoperatively. 

For hand surgeons to perform regional anesthesia, all that is required is a correct knowledge of the prevention of local anesthetic toxicity and accurate needling technique. In this presentation, we present our approach.