New composite scale for evaluating peripheral nerve block quality in upper limb orthopaedics surgery

Area of Science:

• Anesthesiology
• Regional Anesthesia
• Surgical Innovation

Background:

• Ultrasound-guided (UG) peripheral nerve blocks (PNBs) offer advantages in trauma surgery.
• Brachial plexus blockade (BPB) improves analgesia, recovery, and patient satisfaction for upper extremity procedures.
• A validated tool is needed to assess UG PNB quality, patient tolerance, and postoperative pain.

Purpose of the Study:

• To develop and evaluate a novel composite tool for assessing the quality of UG PNBs.
• To compare the efficacy of the new tool with existing methods.
• To evaluate patient outcomes including sensory and motor function, coping, and postoperative pain.

Main Methods:

• Standardized UG BPB (interscalene-supraclavicular and axillary-supraclavicular approaches) were performed for upper limb surgery.
• A novel tool, the Sensory, Motor, Coping, and Postoperative (SMCP) scale, was developed and utilized.
• The SMCP scale, quality of anesthesia graded by anesthesiologist (QAGA), intraoperative parameters, and postoperative pain were compared between groups.

Main Results:

• The SMCP scale identified 97.8% of PNBs as Excellent or Good, significantly higher than the QAGA scale (86%, p < 0.001).
• No surgeries were abandoned due to failed PNB, and no tourniquet pain was reported.
• No significant differences in local anesthetic volume or intraoperative parameters were observed between the two approaches.

Conclusions:

• The novel SMCP evaluation tool comprehensively assesses PNB quality, patient coping, and postoperative pain.
• The SMCP scale demonstrates superior sensitivity in reflecting the high success rate of UG PNBs compared to the QAGA scale.
• This tool enhances the evaluation of UG PNBs, focusing on overall patient condition during and after surgery.