A new axillary approach for continuous brachial plexus block. A clinical and anatomic study

Area of Science:

• Anesthesiology
• Regional Anesthesia
• Pain Management

Background:

• Continuous axillary brachial plexus block is used for hand surgery and analgesia.
• Accurate catheter placement in the neurovascular sheath is crucial for block efficacy.
• Existing techniques may have variable success rates.

Purpose of the Study:

• To compare a novel perivenous technique with the Selander technique for continuous axillary brachial plexus block.
• To evaluate the efficacy and safety of the perivenous technique guided by fluoroscopy and a pre-opacified axillary vein.

Main Methods:

• A randomized study involving 36 ASA grade I-II patients undergoing hand surgery or physiotherapy.
• Group 1 (n=18): Catheter placement using the Selander technique.
• Group 2 (n=18): Catheter placement using the novel perivenous technique under fluoroscopic guidance.

Main Results:

• Complete block success was achieved in 100% of patients in Group 2 versus 50% in Group 1 (P < 0.05).
• No significant differences were observed in procedure time, block duration, pain scores, or bupivacaine dosage.
• Plasma bupivacaine concentrations were low in successful blocks and higher in failed blocks, irrespective of the technique.

Conclusions:

• The perivenous technique offers a higher success rate for continuous axillary brachial plexus block.
• Fluoroscopic guidance and accurate neurovascular sheath localization contribute to improved outcomes.
• This technique is a valuable alternative for achieving effective brachial plexus anesthesia and analgesia.