Liu FC, Liou JT, Tsai YF, Li AH, Day YY, Hui YL, Lui PW. Efficacy of ultrasound-guided axillary brachial plexus block: a comparative study with nerve stimulator-guided method

Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou.
Chang Gung medical journal 07/2005; 28(6):396-402.
Source: PubMed


The aim of this study was to compare the efficacy of axillary brachial plexus block using an ultrasound-guided method with the nerve stimulator-guided method. We also compared the efficacy of ultrasound-guided single-injection with those of double-injection for the quality of the block.
Ninety patients scheduled for surgery of the forearm or hand were randomly allocated into three groups (n = 30 per group), i.e., nerve stimulator-guided and double-injection (ND) group, ultrasound-guided and double-injection (UD) group, and ultrasound-guided and single-injection (US) group. Each patient received 0.5 ml kg(-1) of 1.5% lidocaine with 5 mg kg(-1) epinephrine. Patients in the ND group received half the volume of lidocaine injected near the median and radial nerves after identification using a nerve stimulator. Patients in the UD group received half the volume of lidocaine injected around the lateral and medial aspects of the axillary artery, while those in the US group were given the entire volume near the lateral aspect of the axillary artery. The extent of the sensory blockade of the seven nerves and motor blockades of the four nerves were assessed 40 min after the performance of axillary brachial plexus block.
Seventy percent of the patients in the ND and US groups as well as 73% of the patients in the UD group obtained satisfactory sensory and motor blockades. The success rate of performing the block was 90% in patients in the ND and UD groups and 70% in the US group. The incidence of adverse events was significantly higher in the ND group (20%) compared with that in the US group and the UD group (0%; p = 0.03).
Ultrasound-guided axillary brachial plexus block, using either single- or double-injection technique, provided excellent sensory and motor blockades with fewer adverse events.

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    • "Soeding et al [90] US vs Landmark and paresthesia (40) US quicker and more complete sensory and motor block Less paresthesia with US Liu et al [93] Three groups: US or PNS with double injections vs US with single injection (90) "
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    ABSTRACT: R egional anesthesia has traditionally been performed with the help of a single modality, which has depended on the availability of technology at the time of performance of these blocks. The transitions from pares-thesia-guided to nerve stimulation to ultrasound-guided nerve blocks have helped advance regional anesthesia as a science rather than an art, and have taken it to a higher level of sophistication. However, the visual information ob-tained with the use of ultrasonography remains subject to interpretation by the user and, consequently, is limited by the ability to optimize the sonographic image, variations in formal training of applied ultrasound physics, and overall experience in ultrasonography. Even though ultrasound visualization by itself is presumably associated with minimal risks, the safety claimed by ultrasound enthusiasts may not necessarily result in the safest clinical practice. There is current debate as to whether the use of nerve stimulation or ultra-sonography is superior as a nerve localization instrument for regional anes-thesia; there is also a proposal that the use of dual or multiple guidance modalities may further expand the opportunities to employ regional anesthesia versus use of a single method. Regional anesthesia reliably works if the correct amount of the correct local anesthetic is placed within the correct fascial plane in correct proximity to the nerve. Nerve stimulation is generally able to provide one or two of these objectively, that is, depositing a local anesthetic near the nerve to be blocked. Anesthesiologists traditionally have used larger doses of local anesthetics with this technique to ascertain block success, as it is not possible to stimulate the nerve again after even a small dose of local anesthetic has been deposited. Ultrasonography does not solve all of these problems but it 1 2 3 4 5 6 7 8
    Full-text · Article · May 2011 · Advances in Anesthesia
    • "Supplementation of patchy analgesia with drugs was preferred over the use of additional injections or waiting for longer periods. Both higher[30] and lower[4] requirement of supplementation as compared to our study have been described by previous authors using VIB or the axillary approach.[1231] While comparing the infraclavicular and axillary approaches, Koscielniak-Nielsen and colleagues[26] and Heid and colleagues[10] found the differences in supplementation requirements to be statistically insignificant, thus supporting our findings. "
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    ABSTRACT: Brachial plexus block via the axillary approach is problematic in patients with limited arm mobility. In such cases, the infraclavicular approach may be a valuable alternative. The purpose of our study was to compare axillary and infraclavicular techniques for brachial plexus block in patients undergoing forearm and hand surgeries. After obtaining institutional approval and written informed consent, 60 patients of American Society of Anaesthesiologists grade I or II scheduled for forearm and hand surgeries were included in the study and were randomly allocated into two groups. Brachial plexus block was performed via the vertical infraclavicular approach (VIB) in patients of Group I and axillary approach in Group A using a peripheral nerve stimulator. Sensory block in the distribution of individual nerves supplying the arm, motor block, duration of sensory block, incidence of successful block and various complications were recorded. Successful block was achieved in 90% of the patients in group I and in 87% of patients in group A. Intercostobrachial nerve blockade was significantly higher in group I. No statistically significant difference was found in sensory and motor blockade of other nerves. Both the approaches are comparable, but the VIB scores ahead of axillary block in terms of its ability to block more nerves. The VIB because of its easily identifiable landmarks, a comfortable patient position during the block procedure and the ability to block a larger spectrum of nerves should thus be considered as an effective alternative to the axillary approach.
    No preview · Article · May 2011 · Indian journal of anaesthesia
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    • "According to Liu et al [19], ultrasonography application provides more accomplished sensory and motor blocks. Same researchers also reported that, through ultrasonography they managed to provide a highly sufficient analgesia without any complications in sixteen axillary-block applied cases of final-stage renal failures20. "
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    ABSTRACT: Brachial plexus block is useful for upper extremity surgery, and many techniques are available. The aim of our study was to compare the efficacy of axillary brachial plexus block using an ultrasound technique to the peripheral nerve stimulation technique. 60 patients scheduled for surgery of the forearm or hand were randomly allocated into two groups (n = 30 per group). For Group 1; US, and for Group 2 PNS was applied. The quality and the onset of the sensorial and motor blockade were assessed. The sensorial blockade, motor blockade time and quality of blockade were compared among the cases. The time needed to perform the axillary brachial plexus block averaged is similar in both groups (p > 0.05). Although not significant statistically, it was observed that the sensory block had formed earlier in Group 1 (p > 0.05). But the degree of motor blockade was intenser in Group 1 than in Group 2 (p < 0.05). Ultrasound offers a new possibility for identifiying the nerves of the brachial plexus for regional anesthesia. The ultrasound-guided axillary brachial plexus block is a safe method with faster onset time and better quality of motor blockade compared to peripheral nerve stimulation technique.
    Full-text · Article · Jan 2011 · International Archives of Medicine
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