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Updated: Nov 11, 2025

Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
Published on: January 31, 2025
Safety and efficacy of axillary block for emergency upper limb orthopaedic interventions, where there is no
Deeptiman James1, Meghna Jiwanmall2
1Department of Orthopaedics, Paediatric Orthopaedic Unit, Christian Medical College, Vellore 632004, Tamil Nadu, India.
Background:
. Surgical healthcare across low- and middle-income countries is plagued with concerns over scarcity of anaesthesiologists. Orthopaedic surgeons working in such resource-limited settings are often caught in a dilemma to provide emergency orthopaedic surgical care without an attending anaesthesiologist. Therefore, an effective, low-risk solution is necessary to ensure safe emergency orthopaedic care.
Methods:
. We evaluated the incidence of 'anaesthesia-related complications' and 'intraoperative adjuvant medications' for maintenance of adequate anaesthesia for patients who underwent emergency upper limb procedures at a remote mission hospital in rural central India, from June 2013 to June 2016. Emergency cases where there was no anaesthesio-logist were analyzed. Data were collected from the Hospaa 3 HMS software, orthopaedic surgical logbook and inpatient records from 2013 to 2016.
Results:
. Sixty-eight patients underwent an 'axillary block' for emergency orthopaedic procedures. Twelve (17.6%) patients had partial block and needed adjuvant medications, 1 (1.4%) patient developed ulnar nerve palsy with partial recovery. Seventy-six adjuvant medications were administered at a mean of 1.19 per patient during the intraoperative period.
Conclusions:
. Axillary regional block is an efficacious, low-risk anaesthesia for emergency orthopaedic procedures of the hand, forearm and elbow, in resource-limited settings where an anaesthesiologist is not available.
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