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Awake brachial plexus block for day case upper limb surgery

Rachael Robertson, Miriam Stephens, Craig Clark
NHS Lanarkshire, Glasgow, United Kingdom


Introduction: University Hospital Wishaw (UHW) began performing awake brachial plexus blocks (ABPB) for day-case upper limb procedures in December 2022.


Methods: We performed a retrospective analysis on a subset of upper limb procedures carried out from July-November 2022 using data extracted from Opera. Prospective data was recorded from December 2022-March 2023. GA related costs were based on information from theatre procurement and the BNF. Cost of time in recovery and day surgery (DSU) was based on the hourly rate of a band 5 nurse, obtained from the finance department. Statistical analysis was by an unpaired t-test.


Results: 49 retrospective cases were included; 55% GA and 45% surgical local anaesthetic (LA). After a GA patients spent on average 49 minutes in recovery. Those discharged spent 129 minutes in DSU. Of the 35 prospective cases, there were 11% GA, 14% surgical LA and 75% ABPB. 85% avoided recovery and time in DSU reduced to an average of 96 minutes (34%, p = 0.004). Theatre utilisation increased from 3.5 to 4.4 cases per list (32%, p = 0.162). Approximately £3065 was saved in GA costs, recovery and DSU time.

Conclusions: Results suggest enhanced theatre utilisation, reduced time to discharge and overall improved cost efficiency for day-case upper limb surgery under ABPB.