Axillary brachial plexus blockade: an evaluation of three techniques

Surgical procedures to the distal humerus, elbow, and proximal forearm are ideally suited to regional anesthetic techniques. Selection of the preferred approach is determined by the innervation of the surgical site, the risks of regional anesthesia-related complications, and the preference and experience of the anesthesiologist. The axillary approach to the brachial plexus is the most commonly used because of its ease of performance, patient acceptance, safety, and reliability, particularly for hand and forearm surgery. Nerve location technique does not affect success rate with the supraclavicular and interscalene approaches but it does with axillary approaches. The purpose of this study was to evaluate three techniques of plexus identification in axillary blockade. Sixty-nine American Society of Anesthesiologists grade I to II patients who had undergone orthopedic or traumatological surgical procedures on the upper extremity during a period of 1 year were chosen. After premedication, patients were divided randomly into three groups according to the technique of plexus identification. Group A (n = 23) consisted of those treated with the Winnie technique; group B (n = 23) consisted of those treated with the transarterial technique; group C (n = 23) consisted of those treated with the combination technique. Axillary blockade performed using the combined technique had higher a success rate than blockade performed with the transarterial and Winnie techniques. Our results suggest that all three techniques are reliable for axillary blockade. But the onset, complete blockade time, and quality of analgesia were better with the combined technique than with the transarterial and Winnie techniques.