General Anesthesia, versus Axillary Block for Ambulatory Hand Surgery: randomized prospective study

Abstract

Both axillary brachial plexus block (ABPB) and general anesthesia (GA) have been extensively employed in upper limb surgery. ABPB is one of the most popular and widely used techniques for brachial plexus blocks and the most commonly used techniques to achieve upper limb regional anesthesia. General anesthesia (GA) has been used successfully for surgery of the upper extremities. It has faster induction time; but unfortunately, it might be associated with several undesirable side effects including postoperative pain, postoperative nausea and vomiting, delayed discharge from hospital and postoperative sleep disturbances. Axillary brachial plexus block is an alternative method for anesthesia of the upper extremity. It associated with decrease incidence of postoperative pain and postoperative nausea and vomiting, also the use of regional anesthesia is associated with economic benefits to the heath care facility and improved patient satisfaction). Sleep deprivation is a major problem in surgical patients having a deleterious effect on postoperative recovery, many Factors implicated in postoperative sleep disturbances among them is the severity of the surgical procedure, and the neuroendocrine response to surgery and postoperative pain which mostly needs opioids to control it. Unfortunately opioid analgesia worsens postoperative sleep by decreasing slow-wave sleep (SWS), also cause dose-dependent REM suppression, and arousals during sleep through exerting control over various biological systems).