Continuous axillary brachial plexus block

Continuous axillary brachial plexus block was performed in 597 patients undergoing prolonged operations on the hand. The technique required placement of a 5 cm 23 gauge teflon intravenous catheter in the axillary perivascular sheath. Lidocaine 1.5 per cent or mepivicaine 1.5 per cent (20-40 ml) were used for the initial block dose. Surgery was completed in 77.2 per cent of patients (460) with the axillary block alone while in 19.1 per cent of patients (114) supplementary narcotic administration or additional regional blocks were required. In 3.7 per cent of patients (22) the technique was considered a complete failure. Complications included local anaesthetic toxic reactions (2.85 per cent, 17 cases), nerve injury (0.50 per cent, three cases) and one case of major haematomaformation. The advantages of this technique and the possible complications are discussed.     

Transscalene brachial plexus block: a new posterolateral approach for brachial plexus block

Depending on the approach to the upper brachial plexus, severe complications have been reported. We describe a novel posterolateral approach for brachial plexus block which, from an anatomical and theoretical point of view, seems to offer advantages. Twenty-seven patients were scheduled to undergo elective major surgery of the upper arm or shoulder using this new transscalene brachial plexus block. The success rate was 85.2% for surgery. Two patients required additional analgesia with IV sufentanil. In two others, regional anesthesia was inadequate. The side effects of this technique included reversible recurrent laryngeal nerve blockade in two patients and a reversible Horner syndrome in one patient. Further studies are needed to compare the transscalene brachial plexus block with other approaches to the brachial plexus.     

Quality of axillary brachial plexus block

A perivascular catheter technique (PVT) and a nerve stimulator technique (NST) for axillary brachial plexus block were compared in terms of quality: complete, incomplete or failed blocks. In a randomised series, 30 PVT blocks and 30 NST blocks were performed by three staff anaesthetists. In the NST group, surgical anaesthesia was always achieved, whereas in the PVT group, four blocks required supplementation with general anaesthesia. In both groups eight patients needed supplementation with additional conduction blocks of 1-3 peripheral nerves. It is concluded that a nerve stimulator technique may increase the success rate of axillary brachial plexus block to some extent.     

A comparison of a triple-injection axillary brachial plexus block with the humeral approach

BACKGROUND AND OBJECTIVES: This prospective, randomized, and single-blind study compared effectiveness, performance, onset, and total anesthetic time and complications of the multiple axillary block (median, radial, and musculocutaneous nerves) with the humeral approach. METHODS: One hundred patients were randomly assigned to 2 groups. In group A (axillary) median, radial, and musculocutaneus nerves were located by a nerve stimulator and injections were made. In group H (humeral) all 4 terminal nerves of the brachial plexus were located and injections were made. A total of 40 mL mepivacaine of 1% was used. RESULTS: Complete sensory block of all 6 peripheral nerves occurred in 94% and 79% of patients in groups A and H, respectively (P < .05). The time to perform the block was shorter in group A (8 +/- 4 minutes v 11 +/- 4 minutes; P < .001); onset time was shorter in group A (16 +/- 8 minutes v 21 +/- 9 minutes; P < .05); total anesthetic time was shorter in group A (24 +/- 8 minutes v 33 +/- 10 minutes; P < .0001). Complete motor block was greater in group A (88% v 66%; P < .05). More vascular punctures occurred in group A (22% v 8%, P < .05). CONCLUSION: The triple-injection axillary block was more effective than the humeral approach as it was associated with more cases of sensory and complete motor block and gave shorter performance and onset times.     

超声引导下双侧腋路臂丛阻滞的临床效果

目的探讨神经刺激器联合超声引导与单独使用超声引导行双侧腋路臂丛神经阻滞可行性。方法 44例患者随机均分为两组:超声组(U组)和神经刺激器联合超声组(NU组)。神经阻滞顺序均为桡神经、尺神经、正中神经和肌皮神经,每根神经使用0.5%罗哌卡因5ml进行阻滞。改变针尖位置,靠近神经束并注药,直至所有神经均被浸润。记录桡神经、尺神经、正中神经和肌皮神经阻滞的起效时间,并评价其阻滞成功率。结果 U组桡神经、尺神经感觉阻滞起效时间明显长于NU组(P0.05)。两组各神经阻滞成功率差异无统计学意义;U组4根神经阻滞成功率均为19例(86.4%),明显低于NU组的22例(100.0%)(P0.05)。结论超声引导下行双侧腋路臂丛阻滞是可行的,神经刺激器提高超声引导下双侧腋路臂丛阻滞的成功率。     

超声引导下肌间沟联合腋路臂丛神经阻滞麻醉效果的临床研究

目的探讨超声引导下肌间沟联合腋路臂丛神经阻滞麻醉的效果与安全性。方法随机将48例拟在超声引导下行臂丛麻醉的上肢手术患者分为2组,各24例。M组使用0.5%的罗哌卡因30 m L行单纯肌间沟臂丛阻滞;U组各使用0.5%的罗哌卡因15 mL行肌间沟联合腋路臂丛阻滞。行腋路臂丛阻滞时,各用5 mL局麻药依次注射在尺神经、正中神经和桡神经周围。记录2组神经阻滞操作时间,评估2组主要神经的痛觉阻滞情况、运动阻滞程度。评价麻醉效果,记录操作相关并发症。结果注药30 min后,U组正中神经、尺神经完全阻滞例数显著多于M组,2、3、4、5级运动阻滞程度均显著高于M组,麻醉效果优良率(100%)显著高于M组(75.0%),差异均有统计学意义(P0.05)。M组发生Horner综合征2例、声音嘶哑1例,U组未发生相关并发症。结论超声引导下肌间沟联合腋路臂丛神经阻滞麻醉用于上肢手术,安全可行,麻醉效果良好。     

A new approach to the brachial plexus]

In order to avoid complications such as pneumothorax or subarachnoid injection, the paper proposes a new approach to brachial plexus using a supraclavear route based on the pulse of the subclavian artery and 7th cervical vertebra. Complications are unlikely using this route.     

Emergency axillary brachial plexus block in a patient allergic to atropine

Peripheral nerve blocks can provide a valid alternative for anesthetizing patients with allergy to drugs such as atropine that are often used for general anesthesia. We report the case of a 7-year-old boy (physical status ASA II, weight 28 Kg). Relevant medical history included generalized skin rash and breathing difficulties due to bronchospasm after administration of atropine eyedrops. The boy had never undergone skin testing for allergy. With a diagnosis of distal metaphyseal fracture of the right radius, he was proposed for urgent closed reduction and osteosynthesis of the lesion. After premedication with midazolam, an axillary brachial plexus block with 0.4 mL x Kg(-1) of 1% mepivacaine was performed with the aid of a nerve stimulator. The intervention was uneventful and the patient was free of pain during and after the procedure. Axillary brachial plexus block anesthesia in this pediatric patient was easy to perform, safe, and effective. It provided satisfactory conditions for surgery and made it possible to avoid administering drugs with vagotonic effects that are often used for general anesthesia and require the use of atropine.     

Groin flap immobilization by axillary brachial plexus block anesthesia

Pedicled groin flaps are still widely used as soft tissue coverage in hand surgery. Various methods have been described for immobilization of flaps, such as Ace wraps, plaster, and external fixators. The hands of 5 females and 12 males, totaling 17 patients, with severe injury were reconstructed with groin flaps between 2001 and 2005. Patients were operated on under a combination of axillary block and general anesthesia. Motor block effect of axillary anesthesia was used for immobilization of the upper extremities at groin flap coverage. A combination of axillary brachial plexus block plus general anesthesia had advantages in the prevention of pedicle tension or torsion during the initial recovery period. Reduction of general anesthesia time and improvement of postoperative pain were also observed. Axillary brachial plexus block and general anesthesia are a preferred combination for patients undergoing groin flap operations.