Axillary brachial plexus block in two hundred consecutive patients

Area of Science:

• Anesthesiology
• Surgical Procedures
• Pain Management

Background:

• Axillary brachial plexus block is a common technique for upper limb surgery.
• Assessing indicators for axillary sheath entry and block characteristics is crucial for optimizing anesthesia.
• Patient satisfaction and complication profiles require thorough evaluation.

Purpose of the Study:

• To audit the clinical success rate, neural blockade extent, and complication incidence of axillary sheath entry indicators.
• To evaluate patient satisfaction with minimally-sedated axillary brachial plexus blocks.
• To determine the reliability of paraesthesia, arterial/venous puncture, or sheath tethering for identifying axillary sheath entry.

Main Methods:

• Prospective audit of 200 minimally-sedated patients undergoing upper limb surgery.
• Axillary sheath identification using a 22-gauge needle and four indicators (paraesthesia, vascular puncture, tethering).
• Injection of 50 ml 1.2% alkalinized mepivacaine, followed by mapping of cutaneous block distribution and patient follow-up via questionnaire and interview.

Main Results:

• Overall clinical success rate was 92.5%, increasing to 99% with supplementary nerve blocks.
• Complete anesthesia distal to the elbow was achieved in 85% of patients.
• Complications included mild local anesthetic toxicity (3.5%), axillary tenderness/bruising (12%), and dysesthesias (12.5%), which were generally mild and transient.

Conclusions:

• Axillary brachial plexus block is a highly effective technique for upper limb surgery, with high patient satisfaction.
• While complications can occur, they are typically minor and transient, supporting the safety profile of the procedure.
• The indicators for axillary sheath entry demonstrate reasonable reliability, contributing to successful blockades.