Selective ulnar nerve localization is not essential for axillary brachial plexus block using a multiple nerve...

Area of Science:

• Anesthesiology
• Regional Anesthesia
• Nerve Block Techniques

Background:

• The standard multiple-injection axillary block technique involves locating and separately injecting four distal nerves of the brachial plexus.
• While effective, this method can be time-consuming and technically demanding.
• A simplified approach aims to reduce complexity without compromising efficacy.

Purpose of the Study:

• To compare a simplified triple-injection axillary block technique (omitting the ulnar nerve) with the conventional four-injection technique.
• To evaluate differences in performance time, patient-reported pain during block performance, onset time, and success rate.

Main Methods:

• Eighty-four patients were randomized into two groups: Group IV (four injections) and Group III (three injections, excluding the ulnar nerve).
• Nerve stimulation was used to locate nerves prior to injection.
• Block completion was defined by the presence of analgesia in all sensory areas distal to the elbow.

Main Results:

• The triple-injection technique (Group III) demonstrated a significantly shorter performance time (5 ± 2 min vs. 8 ± 3 min; P < .001).
• Patients in Group III reported significantly less pain during block performance (8 ± 2 mm vs. 13 ± 2 mm; P < .001).
• No significant differences were observed in the onset time (15 ± 6 min vs. 16 ± 7 min) or the frequency of complete block (90% vs. 92%).

Conclusions:

• A triple-injection axillary block, intentionally omitting the ulnar nerve, achieves sensory block spread and latency comparable to the four-injection technique.
• This simplified approach offers a significant advantage in reduced procedure time.
• The triple-injection method is a viable and potentially more efficient alternative for axillary blockade.