[High continuous axillary-brachial plexus anesthesia. Comparison of a new method with perivascular axillary-brachial...

High axillary brachial plexus anaesthesia was performed in 25 patients. This technique employs simple, straight forward axillary access, and produces an infraclavicular brachial plexus block which is adequate for anaesthesia of the entire arm. The technique and the equipment required are described in the text and illustrated by the figures. Twenty patients who received high axillary brachial plexus anaesthesia were compared with 20 patients who received conventional axillary brachial plexus anaesthesia. The arm anaesthesia attained was classified as being of the analgesic or the anaesthetic stage by pin-prick testing at 4-min intervals, and the motor block, as paretic or the paralytic stage. Five incorrect catheter placements (i.e., 20%) were observed in the group with high axillary brachial plexus anaesthesia; however, they could be revised to produce conventional axillary brachial plexus blocks. Blood mepivacaine level determinations performed over a 90-min period showed that the relatively high dosage used (with average 7.29 gm/kg body weight) did not result in toxic blood levels. This technique involves advancing the catheter 8.3-20 cm (mean 13.9 cm) beyond the puncture site. In 11 cases, it was necessary to overcome resistance when advancing the needle. The site of placement was determined by electrostimulation and cold-temperature-testing. Comparison of both groups revealed that the block is faster and more complete, and the nerves which are usually difficult to block with plexus anaesthesia are anaesthetized better with the high axillary block than with the conventional technique. The anaesthesia of the axillary and musculocutaneous nerves showed an impressive improvement. Whereas the usually difficult block of the radial nerve in the hand was greatly improved, the median and ulnar nerves were blocked equally well using either method. The only complication that occurred was an intravenous catheter placement, which was diagnosed and corrected. No other early or late complications were observed following the use of this technique in a large group of patients. This new technique is simple and easy to master.