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Anesth Analg 2000;91:647-651
© 2000 International Anesthesia Research Society

REGIONAL ANESTHESIA AND PAIN MEDICINE

Multiple-Injection Axillary Brachial Plexus Block: A Comparison of Two Methods of Nerve Localization–Nerve Stimulation Versus Paresthesia

Salvatore Sia, MD, Maurizio Bartoli, MD, Antonella Lepri, MD, Osea Marchini, MD, and Paolo Ponsecchi, MD

Department of Anesthesiology, Centro Traumatologico Ortopedico, Firenze, Italy

Address correspondence and reprint requests to Salvatore Sia, MD, Via Santelli, 41, 50134 Firenze, Italy.

We conducted this prospective study to compare the onset time and the success rate of a multiple-injection axillary brachial plexus block performed by using two methods of nerve localization: paresthesia elicitation or nerve stimulation. Each of the major nerves of the plexus was located by elicitation of a paresthesia (Group PAR; n = 50) or by nerve stimulation (Group PNS; n = 50) and injected with 10 mL of local anesthetic solution. Time to perform the block, onset time of the primary block, time to achieve readiness for surgery, and total anesthetic time were significantly shorter in Group PNS than in Group PAR. The incidence of complete block was larger in Group PNS than in Group PAR (91% vs 76%; P < 0.05), and this was related to a larger success rate for anesthetizing the radial and the musculocutaneous nerves (P < 0.05). The frequency of venous puncture was larger in Group PAR (P < 0.05). For multiple-injection axillary brachial plexus block, we conclude that nerve stimulation resulted in a greater success rate and a faster onset than paresthesia elicitation, and it should be considered when the radial and musculocutaneous nerve distributions are involved in the surgical area.

Implications: Two methods of nerve localization were compared when performing an axillary brachial plexus block by the multiple-injection technique. Nerve stimulation provided a faster onset and a greater incidence of complete block, related to a better success rate for anesthetizing the radial and the musculocutaneous nerves, than paresthesia elicitation.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2000 by the International Anesthesia Research Society.