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Anesth Analg 2008; 107:1754-1755
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e31818454ec
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ANALGESIA

Intravascular Injection During Ultrasound-Guided Axillary Block: Negative Aspiration Can Be Misleading

Christopher Robards, MD, Steven Clendenen, MD, and Roy Greengrass, MD

From the Department of Anesthesiology, Mayo Clinic Jacksonville, Jacksonville, Florida.

Address correspondence and reprint requests to Christopher B. Robards, Mayo Clinic Jacksonville, San Pablo Road, Jacksonville, FL 32224. Address e-mail to Robards.christopher{at}mayo.edu.

Abstract

Needle visualization is an advantage of ultrasound-guided nerve blocks compared to traditional methods of nerve localization. However, visualization of local anesthetic spread is also important. During an ultrasound-guided axillary block, there was negative aspiration for blood. However, the absence of local anesthetic spread on ultrasound imaging suggested possible intravascular injection. The ultrasound transducer was removed from the patient's arm and venous blood was aspirated from the nerve block needle. Pressure applied to an ultrasound transducer can occlude venous structures making negative aspiration of blood unreliable for excluding intravascular needle placement.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2008 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2008 by the International Anesthesia Research Society.