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Ultrasound guidance improves success rate of axillary brachial plexus block

[L’échoguidage améliore le taux de succès du bloc axillaire du plexus brachial]

Vincent W.S. Chan, MD FRCPS^*,, Anahi Perlas, MD FRCPC^*,, Colin J.L. McCartney, MBChB FRCA FFARCSI FRCPC^*,, Richard Brull, MD FRCPC^*,, Daquan Xu, MB MSc and Sherif Abbas, MD

^* From the Departments of Anesthesia, University of Toronto and
Anesthesia & Pain Management, University Health Network, Toronto, Ontario, Canada.

Address correspondence to: Dr. Vincent W.S. Chan, Toronto Western Hospital, Department of Anesthesia, 2MC- 405, 399 Bathurst St, Toronto, Ontario M5T 2S8, Canada. Phone: 416-603-5118; Fax: 416-603 6494; E-mail: vincent.chan{at}uhn.on.ca

Purpose: The purpose of this study is to determine if real time ultrasound guidance improves the success rate of axillary brachial plexus blockade.

Methods: Patients undergoing elective hand surgery were randomly assigned to one of three groups. Axillary blocks were performed using three motor response endpoints in the nerve stimulator (NS) Group, real-time ultrasound guidance in the ultrasound (US) Group and combined ultrasound and nerve stimulation in the USNS Group. Following administration of a standardized solution containing 2% lidocaine with 1:200,000 epinephrine and 0.5% bupivacaine (total 42 mL), sensory and motor functions were assessed by a blinded observer every five minutes for 30 min. A successful block was defined as complete sensory loss in the median, radial and ulnar nerve distribution by 30 min. The need for local and general anesthesia supplementation and post-block adverse events were documented.

Results: One hundred and eighty-eight patients completed the study. Block success rate was higher in Groups US and USNS (82.8% and 80.7%) than Group NS (62.9%) (P = 0.01 and 0.03 respectively). Fewer patients in Groups US and USNS required supplemental nerve blocks and/or general anesthesia. Postoperatively, axillary bruising and pain were reported more frequently in Group NS.

Conclusion: This study demonstrates that ultrasound guidance, with or without concomitant nerve stimulation, significantly improves the success rate of axillary brachial plexus block.

Related articles in CJA:

Ultrasound-guidance and nerve stimulation: implications for the future practice of regional anesthesia/Échoguidage et neurostimulation : implications pour la pratique future de l’anesthésie régionale

Ban Tsui
CJA 2007 54: 165-170. [Full Text]  

This article has been cited by other articles:

				J. Aguirre, S. Blumenthal, and A. Borgeat Ultrasound guidance and success rates of axillary brachial plexus block - I Can J Anesth, July 1, 2007; 54(7): 583 - 583. [Full Text] [PDF]

				S. Mannion and X. Capdevila Ultrasound guidance and success rates of axillary brachial plexus block - II Can J Anesth, July 1, 2007; 54(7): 584 - 584. [Full Text] [PDF]

				A. Perlas, V. W.S. Chan, and R. Brull REPLY Can J Anesth, July 1, 2007; 54(7): 584 - 585. [Full Text] [PDF]

				B. Tsui Ultrasound-guidance and nerve stimulation: implications for the future practice of regional anesthesia/Echoguidage et neurostimulation : implications pour la pratique future de l'anesthesie regionale Can J Anesth, March 1, 2007; 54(3): 165 - 170. [Full Text] [PDF]