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Paresthesiae or no paresthesiae? Nerve lesions after axillary blocks
Acta Anaesthesiologica Scandinavica
|February 1, 1979
Summary
Avoiding paresthesia (nerve sensation) during peripheral nerve blocks may reduce the risk of post-anesthetic neurological complications. This study found fewer nerve lesions when blocks were guided by arterial pulsations rather than nerve stimulation.
Area of Science:
- Anesthesiology
- Neurology
- Surgical Procedures
Background:
- Peripheral nerve blocks are common for hand surgery.
- Seeking paresthesiae during nerve block placement is a debated technique.
- Potential for nerve injury exists with peripheral nerve blocks.
Purpose of the Study:
- To investigate if actively seeking paresthesiae during axillary block increases the risk of post-anesthetic neurological sequelae.
- To compare nerve block outcomes when using arterial pulsations versus paresthesia for needle guidance.
Main Methods:
- Prospective study of 533 patients undergoing hand surgery with axillary block.
- Two groups: one seeking paresthesiae, the other using axillary artery pulsations for guidance.
- Mepivacaine with or without adrenaline was administered.
Main Results:
- Ten patients experienced postanesthetic nerve lesions; eight in the paresthesia group, two in the artery group.
- All affected patients received mepivacaine with adrenaline.
- Nerve lesion symptoms ranged from mild paresthesiae to severe, long-lasting deficits.
Conclusions:
- Actively seeking paresthesiae during axillary nerve blocks may be associated with a higher risk of nerve injury.
- Using axillary artery pulsations for guidance appears to be a safer alternative.
- Nerve blocks should ideally be performed without intentionally eliciting paresthesiae to minimize neurological sequelae.