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Brachial plexus anesthesia and axillary sheath elastance.

R L Lennon, J W Linstromberg

    Anesthesia and Analgesia
    |February 1, 1983
    PubMed
    Summary
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    Axillary block anesthesia with large anesthetic volumes is unlikely to cause dangerous arterial compression. Studies show that axillary sheath pressure remains below mean arterial pressure, ensuring adequate blood flow during regional anesthesia.

    Area of Science:

    • Anesthesiology
    • Regional Anesthesia
    • Vascular Physiology

    Background:

    • High-volume anesthetic injections in regional axillary anesthesia can increase axillary sheath pressure.
    • Elevated pressure may lead to arterial compression and reduced blood flow, potentially compromising limb perfusion.

    Purpose of the Study:

    • To measure axillary sheath pressure in response to increasing volumes of anesthetic solution.
    • To determine the relationship between injected volume and pressure within the axillary sheath.
    • To assess the risk of arterial compression and vascular insufficiency during axillary block anesthesia.

    Main Methods:

    • Twenty patients undergoing hand surgery received bupivacaine (without epinephrine) via axillary sheath injection in 10-ml increments up to 50 ml.

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  • Axillary sheath pressure was continuously monitored.
  • Elastance (change in pressure/change in volume) was calculated for successful and unsuccessful blocks.

    • Main Results:

    • Axillary sheath pressure did not exceed mean arterial pressure for durations exceeding 60 seconds.
    • Elastance values were 0.8 +/- 0.1 mm Hg/ml for successful blocks and 0.09 +/- 0.1 mm Hg/ml for unsuccessful blocks.
    • The study demonstrated a predictable pressure-volume relationship within the axillary sheath.

    Conclusions:

    • Regional axillary anesthesia using large anesthetic volumes is unlikely to cause significant arterial compression.
    • The risk of vascular insufficiency due to arterial compression following axillary block is minimal.
    • This study supports the safety of current anesthetic volumes used in axillary blocks.