Abstract
Introduction
Brachial plexus blocks are used widely to provide intra-operative and post-operative analgesia. Their efficacy is well established, but little is known about discharging patients with a numb or weak arm. We need to quantify the risk of complications for improved informed consent.
Objectives
To assess whether patients can be safely discharged from hospital before the brachial plexus block has worn off and record any complications and concerns.
Study design
Prospective cohort study
Methods
319 consecutive patients who had a brachial plexus block alone or combined with a general anaesthetic for upper limb surgery were assessed. The adequacy of the block and the outcome of the block was assessed.
Results
238 patients received a general anaesthetic as well as the block and 81 patients received a brachial plexus block alone. The mean time to discharge was 27.5 hours (2-308 hours). Sensation recovered in 15.8 hours (SD- 15.9) and motor power recovered in 15.6 hours (SD- 13.3). The most frequent complication was swelling of the limb which occurred in 8 patients. 7 patients (2.2%) developed Horner's syndrome, 4 patients (1.3%) developed phrenic nerve anaesthesia and 2 patients (0.6%) developed a pneumothorax. Eleven patients had prolonged numbness of >24 hours following the block without any untoward effect. 287 patients (90%) were happy to care for themselves following discharge.
Conclusion
Patients can be discharged before the brachial plexus block has worn off with good advice. Patients should be warned of symptoms of Horner's syndrome and phrenic nerve anaesthesia.
