Anesth Pain Med.  2017 Oct;12(4):357-362. 10.17085/apm.2017.12.4.357.

Effect of needle approach to the axillary artery on transarterial axillary brachial plexus block quality

• Chang YJ
• Lee DC
• Oh YJ
• Ha DH
• Lee MG

• KMID: 2405855
• DOI: http://doi.org/10.17085/apm.2017.12.4.357

Abstract

BACKGROUND
The authors sought to determine whether a shallow needle approach to the axillary artery would improve complete sensory blocks of median, radial, and ulnar nerves as compared with a perpendicular approach when transarterial axillary block is performed using a scalp vein needle (23G, 3/4').
METHODS
Fifty-four patients were allocated equally to a perpendicular group (the PA group) or a shallow approach group (SA group). Sensory and motor scores were evaluated and compared in the two groups at 5-minute intervals for 20 minutes after block. The main outcome variables were rates of blockage of median, radial, and ulnar nerves.
RESULTS
Excellent block rates (defined as completion of surgery using brachial plexus block alone) were obtained in both groups (SA group 77.8% vs. PA group 70.3%, P = 0.755). However, the rate of blockage of all three nerves was significantly higher in the SA group (74% vs. 40.7%, P = 0.013). Furthermore, the rate of complete sensory block of the radial nerve at 20 minutes was significantly greater in the SA group (85.2% vs. 59.3%, P = 0.033).
CONCLUSIONS
A shallow needle approach to the axillary artery resulted in a significantly higher median, radial, and ulnar nerve block rate at 20 minutes after LA injection than a perpendicular approach.

Keyword

Scalp vein needle; Transarterial axillary brachial plexus block

MeSH Terms

Axillary Artery*
Brachial Plexus Block*
Brachial Plexus*
Humans
Needles*
Radial Nerve
Scalp
Ulnar Nerve
Veins

Figure

• 

  Fig. 1 Perpendicular approach group (PA group) versus the shallow needle approach group (SA group). When the scalp vein needle (23 G, 3/4’) was advanced into the axillary artery, the needle was directed perpendicular to the axillary artery in the PA group (A), whereas in the SA group, a shallow needle approach to the axillary artery was used (B).

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