A Comparison of Four Stimulation Patterns in Axillary Block

Rodríguez, Jaime; Taboada, Manuel; DELRIO, S; Bárcena, María; Álvarez, J.

doi:10.1016/j.rapm.2005.04.001

Cited by 20 publications

(23 citation statements)

References 11 publications

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“…Multiple injections block the brachial plexus more successfully and rapidly than one injection when guided by surface anatomy, paraesthesia or electrical neurostimulation [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

A systematic review of ultrasound‐guided methods for brachial plexus blockade

et al. 2015

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SummaryWe systematically reviewed 25 randomised controlled trials of ultrasound-guided brachial plexus blockade that recruited 1948 participants: either one approach vs another (axillary, infraclavicular or supraclavicular); or one injection vs multiple injections. There were no differences in the rates of successful blockade with approach, relative risk (95% CI): axillary vs infraclavicular, 1.0 (1.0-1.1), p = 0.97; axillary vs supraclavicular, 1.0 (1.0-1.1), p = 0.68; and infraclavicular vs supraclavicular, 1.0 (1.0-1.1), p = 0.32. There was no difference in the rate of successful blockade with the number of injections, relative risk (95% CI) 1.0 (1.0-1.0), p = 0.69, for one vs multiple injections. The rate of procedural paraesthesia was less with one injection than multiple injections, relative risk (95% CI) 0.6 (0.4-0.9), p = 0.004.

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“…Multiple injections block the brachial plexus more successfully and rapidly than one injection when guided by surface anatomy, paraesthesia or electrical neurostimulation [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

A systematic review of ultrasound‐guided methods for brachial plexus blockade

et al. 2015

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“…by a nerve stimulator and separately injected, reportedly provides a short onset time [24,25]. Zhao et al showed that a complete block could be obtained in 94.4% of patients receiving a low concentration of levobupivacaine (36 mL, 0.1%) using this technique [30].…”

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confidence: 99%

Parecoxib Added to Ropivacaine Prolongs Duration of Axillary Brachial Plexus Blockade and Relieves Postoperative Pain

Liu

Zhao

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Cyclooxygenase (COX)-2 antagonist is widely used for intravenous postoperative pain relief. Recent studies reported COX-2 in the spinal dorsal horn could modulate spinal nociceptive processes. Epidural parecoxib in rats showed no neurotoxicity. These findings suggested applying a COX-2 antagonist directly to the central or peripheral nerve might provide better analgesia. Questions/purposes We therefore determined: (1) whether the addition of parecoxib to ropivacaine injected locally on the nerve block affected the sensory and motor block times of the brachial plexus nerve block; and (2) whether parecoxib injected locally on the nerve or intravenously had a similar analgesic adjuvant effect.Methods We conducted a randomized controlled trial from January 2009 to November 2010 with 150 patients scheduled for elective forearm surgery, using a multiplenerve stimulation technique. Patients were randomly allocated into one of three groups: Group A (n = 50) received ropivacaine 0.25% alone on the brachial plexus nerve; Group B (n = 50) received ropivacaine together with 20 mg parecoxib locally on the nerve block; and Group C (n = 50) received 20 mg parecoxib intravenously. We recorded the duration of the sensory and motor blocks, and the most severe pain score during a 24-hour postoperative period.

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“…As the success rate in our study for radial nerve blockade was lower in the two-injection group, multiple-injection technique must be preferred in the surgical procedures to be performed on the areas innerved by the radial nerve. If the smaller number of injections is preferred, the radial nerve must be blocked separately (15 musculocutaneous nerve, median nerve and radial nerve in the other group. They found similar patient satisfaction rates in both the groups, and an additional drug requirement for sedation was less in the multiple injection group.…”

Section: Discussionmentioning

confidence: 99%

Comparison Between the Two-Injection Technique and the Four-Injection Technique in Axillary Brachial Plexus Block with Articaine

Ertikin¹,

Argun²,

Mısırlıoğlu³

et al. 2017

Turk J Anaesth Reanim

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Objective:In this study, we aimed to compare axillary brachial plexus block using the two-injection and four-injection techniques assisted with ultrasonography (USG) and nerve stimulator in patients operated for carpal tunnel syndrome with articaine. To evaluate which technique is more effective, we compared the onset time, effectiveness, and duration of block procedures, patient satisfaction, adverse effect of the drug, and complication rates of the motor and sensory blocks. Methods: Sixty patients were randomly divided into two groups. A mixture of physiologic serum added to articain with NaHCO 3 (30 mL) was injected into the patients' axilla in both the groups. After the blockage of the musculocutaneous nerve in both the groups, the median nerve in the two-injection group and the median nerve, ulnar nerve, and radial nerve in the four-injection group were blocked. In brachial plexus nerves, sensorial blockage was evaluated with pinprick test, and motor block was evaluated by contraction of the muscles innervated by each nerve. The adverse effects and complications, visual analog scale (VAS) values during the operation, and post-operative patient satisfaction were recorded. Results: Sufficient analgesia and anaesthesia were achieved with no need for an additional local anaesthetics in both the groups. Furthermore, additional sedation requirements were found to be similar in both the groups. A faster rate and a more effective complete block were achieved in more patients from the four-injection group. In the two-injection group, the block could not be achieved for N. radialis in one patient. All other nerves were successfully blocked. Whereas the blockage procedure lasted longer in the four-injection group, the VAS values recorded during the blockage procedure were higher in the four-injection group. No statistical difference was found with regard to patient satisfaction, and no adverse effects and complications were observed in any group. Conclusion: Although the multi-injection method takes more time, it provides faster anaesthesia and more complete blockage than the two-injection method used with articain. The two-injection method can also be used in specific surgery such as for carpal tunnel syndrome, as an alternative to multi-injection method. Keywords: Brachial block, ultrasonography, neurostimulator, four-injection technique, articain Amaç: Bu çalışmada ultrason ve sinir stimulatörü eşliğinde karpal tünel sendromu cerrahisi geçiren hastalarda, artikain ile yapılan aksiler brakial pleksus bloğunda ikili ve dörtlü enjeksiyon teknikleri karşılaştırılması amaçlanmıştır. Hangi tekniğin daha etkili olduğu-nu değerlendirebilmek için; blok etkisinin başlangıç zamanı, etkinliği, blok süresi, hasta memnuniyeti, ilacın yan etkisi ve motor ve duyu bloğunun komplikasyon oranları karşılaştırıldı. Yöntemler: Altmış hasta randomize olarak iki gruba ayrıldı. Artikain, sodyum bikarbonat ve serum fizyolojik karışımı 30 mL'ye tamamlanarak her iki gruba uygulandı. Her iki grupta muskülo-kütan sinir blokajı sonrası, ikili en...

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A Comparison of Four Stimulation Patterns in Axillary Block

Abstract: Musculocutaneous-nerve stimulation and radial-nerve stimulation play predominant roles in the success of axillary brachial plexus block, although a triple-nerve stimulation technique is still required to produce complete anesthesia of the upper limb.

Cited by 20 publications

References 11 publications

A systematic review of ultrasound‐guided methods for brachial plexus blockade

A systematic review of ultrasound‐guided methods for brachial plexus blockade

Parecoxib Added to Ropivacaine Prolongs Duration of Axillary Brachial Plexus Blockade and Relieves Postoperative Pain

Comparison Between the Two-Injection Technique and the Four-Injection Technique in Axillary Brachial Plexus Block with Articaine

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