J Korean Orthop Assoc.  2018 Dec;53(6):513-521. 10.4055/jkoa.2018.53.6.513.

Ultrasound-Guided Axillary Brachial Plexus Block, Performed by Orthopedic Surgeons

• Kim CU
• Lee CH
• Yoon JY
• Rhee SK

• KMID: 2430058
• DOI: http://doi.org/10.4055/jkoa.2018.53.6.513

Abstract

PURPOSE
The purpose of this study was to assess the effectiveness and complications of an ultrasound-guided axillary brachial plexus block performed by orthopedic surgeons.
MATERIALS AND METHODS
From March to May 2017, an ultrasound-guided axillary brachial plexus block was performed on a total of 103 cases of surgery. A VF13-5 transducer from Siemens Acuson X300 was used. The surgical site was included in the range of the anatomic sensory distribution of the blocked nerve, except for the case where an operation time of more than 2 hours was expected due to multiple injuries and the operation of the upper arm. The procedure was performed by 2 orthopedic surgeons in the same method using 50 ml of solution (20 ml of lidocaine HCl in 2%, 20 ml of ropivacaine in 0.75%, 10 ml of normal saline in 0.9%). The success rate of anesthesia induction during surgery, anesthetic induction time, anatomical range of operation, duration of postoperative analgesia and complications were investigated.
RESULTS
The results from the 2 practices were similar. The anesthesia was successful in 100 out of 103 patients (97.1%). In these patients, the average needling time was 5.5 minutes (2.5-13.2 minutes), the average induction time to complete anesthesia was 18.4 minutes (5-40 minutes), and the average duration of postoperative analgesia was 402.8 minutes (141-540 minutes). The post-anesthesia immediate complications were dizziness in 1 case, nausea and vomiting in 4 cases, and peri-oral numbness in 2 cases, but surgery was performed without problems. All these 7 cases with complications recovered on the same day. A total of 3 cases failed with anesthesia, and they were treated by an injection with local anesthesia in the operation room in 2 cases and switched to general anesthesia in 1 case.
CONCLUSION
An ultrasound-guided axillary brachial plexus block, which was performed by orthopedic surgeons allows anesthesia in a brief period and the high success rates of anesthesia for certain surgeries of the elbow and surgeries on forearm, wrist and hand. Therefore, it can reduce the waiting time to the operating room. This technique is a relatively safe procedure and dose selective anesthesia is possible.

Keyword

ultrasound-guided; axillary brachial plexus block; orthopedic surgeons

MeSH Terms

Analgesia
Anesthesia
Anesthesia, General
Anesthesia, Local
Arm
Brachial Plexus Block*
Brachial Plexus*
Dizziness
Elbow
Forearm
Hand
Humans
Hypesthesia
Lidocaine
Methods
Multiple Trauma
Nausea
Operating Rooms
Orthopedics*
Surgeons*
Transducers
Vomiting
Wrist
Lidocaine

Figure

• 

  Figure 1 (A, C, D) Patient position and the location of the probe for performing axillary brachial plexus block. (B) Anesthetic preparation composed of lidocaine HCl 2% 20 ml, ropivacaine 0.75% 20 ml, 0.9% normal saline 10 ml, 50 ml syringe, 23-guage spinal needle and intravenous extension line. (E) In-plane needling for axillary brachial plexus block.

• 

  Figure 2 (A) Ultrasound anatomy of axilla. (B) In-plane needle approching (arrows). AA, axillary artery; M, median nerve; U, ulnar nerve; R, radial nerve; MC, musculocutaneous nerve; CBM, coracobrachialis muscle.

• 

  Figure 3 (A–D) Left pictures: before injection; Right pictures: after injection, each nerves are surrounded by hypoechoic local anesthetics on right pictures each. (A) Musculocutaneous nerve block. On left picture: the needle tip is located between the MCN and the fascia of CBM (arrow). (B) Radial nerve block. (C) Median nerve (arrow) block. (D) Ulnar nerve (arrow) block. AA, axillary artery; CBM, coracobrachialis muscle; MCN, musculocutaneous nerve; R, radial nerve; M, median nerve; U, ulnar nerve. Arrowheads in all pictures are indicate needle.

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