Ultrasound guidance improves the success rate of a perivascular axillary plexus block

Authors

  • B. D. Sites,

    Corresponding author
    1. Departments of Anesthesiology and Orthopedic Surgery, Dartmouth Medical School, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
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  • M. L. Beach,

    1. Departments of Anesthesiology and Orthopedic Surgery, Dartmouth Medical School, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
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  • B. C. Spence,

    1. Departments of Anesthesiology and Orthopedic Surgery, Dartmouth Medical School, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
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  • C. W. Wiley,

    1. Departments of Anesthesiology and Orthopedic Surgery, Dartmouth Medical School, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
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  • J. Shiffrin,

    1. Departments of Anesthesiology and Orthopedic Surgery, Dartmouth Medical School, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
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  • G. S. Hartman,

    1. Departments of Anesthesiology and Orthopedic Surgery, Dartmouth Medical School, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
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  • J. D. Gallagher

    1. Departments of Anesthesiology and Orthopedic Surgery, Dartmouth Medical School, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
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  • These data were presented as an abstract for the American Society of Anesthesiologists Annual Meeting, October 2005.

Brian D. Sites
Department of Anesthesiology
Dartmouth-Hitchcock Medical Center
One Medical Center Drive
Lebanon
New Hampshire 03756
USA
e-mail: brian.sites@hitchcock.org

Abstract

Background:  Traditional approaches to performing brachial plexus blocks via the axillary approach have varying success rates. The main objective of this study was to evaluate if a specific technique of ultrasound guidance could improve the success of axillary blocks in comparison to a two injection transarterial technique.

Methods:  Fifty-six ASA physical status I–III patients presenting for elective hand surgery were prospectively randomized to receive an axillary block performed by either a transarterial technique (Group TA) or an ultrasound-guided perivascular approach (Group US). Both groups received a total of 30 ml of 1.5% lidocaine (225 mg) with 5 μg/ml epinephrine. Patients were then evaluated for block onset in specific nerve distributions and whether or not the block acted as a surgical anesthetic.

Results:  Group TA sustained more failures defined as conversion to general anesthesia or the inability to localize the artery [Group TA eight patients (29%) vs. Group US in which 0 patients required conversion to general anesthesia (0%) P < 0.01]. Group US demonstrated a reduction in performance times vs. Group TA (7.9 ± 3.9 min vs. 11.1 ± 5.7 min, P < 0.05). By 30 min post-injection, there were no significant differences between groups TA and US in terms of the proportion of patients demonstrating a complete motor or sensory loss.

Conclusion:  Ultrasonographic guidance improves the overall success rate of axillary blocks in comparison to a transarterial technique.

Ancillary