Yonsei Med J.  2015 May;56(3):838-844. 10.3349/ymj.2015.56.3.838.

Comparison of Ultrasound-Guided Axillary Brachial Plexus Block Techniques: Perineural Injection versus Single or Double Perivascular Infiltration

• Cho S
• Kim YJ
• Baik HJ
• Kim JH
• Woo JH

• KMID: 2450362
• DOI: http://doi.org/10.3349/ymj.2015.56.3.838

Abstract

PURPOSE
We compared three methods of ultrasound-guided axillary brachial plexus block, which were single, and double perivascular (PV) infiltration techniques, and a perineural (PN) injection technique.
MATERIALS AND METHODS
78 patients of American Society of Anesthesiologists physical status I-II undergoing surgery of the forearm, wrist, or hand were randomly allocated to three groups. 2% lidocaine with epinephrine 5 microg/mL was used. The PN group (n=26) received injections at the median, ulnar, and radial nerve with 8 mL for each nerve. The PV1 group (n=26) received a single injection of 24 mL at 12-o'clock position of the axillary artery. The PV2 group (n=26) received two injections of 12 mL each at 12-o'clock and 6-o'clock position. For all groups, musculocutaneous nerve was blocked separately.
RESULTS
The PN group (391.2+/-171.6 sec) had the longest anesthetic procedure duration than PV1 (192.8+/-59.0 sec) and PV2 (211.4+/-58.6 sec). There were no differences in onset time. The average induction time was longer in PN group (673.4+/-149.6 sec) than PV1 (557.6+/-194.9 sec) and PV2 (561.5+/-129.8 sec). There were no differences in the success rate (89.7% vs. 86.2% vs. 89.7%).
CONCLUSION
The PV injection technique consisting of a single injection in 12-o'clock position above the axillary artery in addition to a musculocutaneous nerve block is equally effective and less time consuming than the PN technique. Therefore, the PV technique is an alternative method that may be used in busy clinics or for difficult cases.

Keyword

Brachial plexus; nerve block; ultrasonography

MeSH Terms

Adult
Anesthetics, Local/*administration & dosage/adverse effects
Brachial Plexus/*drug effects/*ultrasonography
Brachial Plexus Block/adverse effects/*methods
Female
Forearm/surgery
Hand/surgery
Humans
Injections
Male
Middle Aged
Peripheral Nerves/ultrasonography
Prospective Studies
Single-Blind Method
Treatment Outcome
*Ultrasonography, Interventional
Upper Extremity/innervation/*surgery
Vascular System Injuries/etiology
Wrist/surgery
Anesthetics, Local

Figure

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  Fig. 1 Percentage of patients with sensory anesthesia (no pinprick) according to time in the cutaneous distributions of the medial, ulnar, radial, and musculocutaneous nerves. *p<0.017 (use of Bonferroni correction) compared with PN group. PN group: perineural injection group-around the median, ulnar, and radial nerve, individually. PV1 group: perivascular injection group-1 spot at direction 12-o'clock. PV2 group: perivascular injection group-2 spots at direction of 12- and 6-o'clock.

• 

  Fig. 2 Percentage of patients with motor paralysis (score of 2) according to time in the distributions of the medial, ulnar, radial, and musculocutaneous nerves. *p<0.017 (use of Bonferroni correction) compared with PN group. PN group: perineural injection group-around the median, ulnar, and radial nerve, individually. PV1 group: perivascular injection group-1 spot at direction 12-oʼclock. PV2 group: perivascular injection group-2 spots at direction of 12- and 6-oʼclock.

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