The efficacy of axillary block for surgical procedures about the elbow

Surgical procedures to the distal humerus, elbow, and proximal ulna and radius are ideally suited to regional techniques. However, axillary block is usually not recommended for surgery about the elbow because blockade at this level may result in inadequate block of the terminal nerves that arise from the medial, posterior, and lateral cords, and provide sensory innervation to the upper arm. This study reports the success rates for interscalene, supraclavicular, and axillary blocks for surgery about the elbow. Three hundred thirty surgical procedures in 260 patients were reviewed retrospectively. Approach to the brachial plexus (interscalene, supraclavicular, axillary), anesthetic technique (paresthesia, nerve stimulator, transarterial), and local anesthetic solution were recorded. Success rate, defined as the percent of cases in which the block provided adequate surgical anesthesia, and the frequency of perioperative respiratory compromise were also determined. In 156 cases, the surgical procedure involved a bony structure. The surgery involved only soft tissue in the remaining 174 cases. Adequate surgical anesthesia was present in 283 cases, for an overall success rate of 86%. Adequate surgical anesthesia was present in 219 of 247 axillary (89%), 46 of 59 supraclavicular (78%), and 18 of 24 interscalene (75%) blocks (P < 0.025). Successful axillary block was achieved in 95% of blocks using paresthesia technique, 88% of blocks using a nerve stimulator/motor response, 94% of combination blocks (paresthesia or nerve stimulator combined with transarterial injection), and 81% of blocks performed exclusively with transarterial injection (P < 0.05). In addition, axillary blocks performed with mepivacaine had a higher success rate (93%) than those performed with bupivacaine (81%) (P < 0.01). There were no patients with perioperative respiratory compromise. These results demonstrate that the axillary approach to the brachial plexus may be successfully used for surgical procedures about the elbow.