Ultrasound guidance improves the success rate of a perivascular axillary plexus block

• Published in: Acta anaesthesiologica Scandinavica 2006-07, Vol.50 (6), p.678-684
• Main Authors: Sites, B. D., Beach, M. L., Spence, B. C., Wiley, C. W., Shiffrin, J., Hartman, G. S., Gallagher, J. D.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local; axillary block; Biological and medical sciences; brachial plexus; Brachial Plexus - diagnostic imaging; Epinephrine; Female; Hand - surgery; Humans; Injections, Intra-Arterial; Lidocaine; Male; Medical sciences; Middle Aged; Monitoring, Intraoperative; Nerve Block; Orthopedic Procedures; Prospective Studies; Single-Blind Method; Treatment Failure; Ultrasonography; ultrasound; upper extremity; Vasoconstrictor Agents
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1111/j.1399-6576.2006.01042.x

Background:  Traditional approaches to performing brachial plexus blocks via the axillary approach have varying success rates. The main objective of this study was to evaluate if a specific technique of ultrasound guidance could improve the success of axillary blocks in comparison to a two injection transarterial technique. Methods:  Fifty‐six ASA physical status I–III patients presenting for elective hand surgery were prospectively randomized to receive an axillary block performed by either a transarterial technique (Group TA) or an ultrasound‐guided perivascular approach (Group US). Both groups received a total of 30 ml of 1.5% lidocaine (225 mg) with 5 μg/ml epinephrine. Patients were then evaluated for block onset in specific nerve distributions and whether or not the block acted as a surgical anesthetic. Results:  Group TA sustained more failures defined as conversion to general anesthesia or the inability to localize the artery [Group TA eight patients (29%) vs. Group US in which 0 patients required conversion to general anesthesia (0%) P < 0.01]. Group US demonstrated a reduction in performance times vs. Group TA (7.9 ± 3.9 min vs. 11.1 ± 5.7 min, P < 0.05). By 30 min post‐injection, there were no significant differences between groups TA and US in terms of the proportion of patients demonstrating a complete motor or sensory loss. Conclusion:  Ultrasonographic guidance improves the overall success rate of axillary blocks in comparison to a transarterial technique.