Severe paralysis of the upper limb after axillary brachial plexus block]

A case is reported of a severe neurological deficit occurring after axillary blockade. The 37-year-old ASA I patient underwent an axillary block for hand surgery using 20 ml of lignocaine 1% with adrenaline and 20 ml of lignocaine 2%. In order to elicit paraesthesia, several attempts were required. Injection of the local anaesthetic was not painful. The tourniquet remained at 250 mmHg for only 35 min. The following day, the patient's arm remained numb. As there was no improvement, epineurotomy was carried out on day 19, to liberate the median nerve which was severely stenosed at the axilla. The patient then started to improve slowly, so that he was able to return to part-time work 6 months later. Prevention of such an accident relies on avoiding intraneural injection and repeated punctures when searching for paraesthesia. When using axillary blockade in day-care surgery, the patient's must be informed upon the possibility of persistent paraesthesia. Should such a rare incident occur, rapid consultation with the anaesthesiologist is essential.