Axillary brachial plexus block

Monkowski, Daniel P.

doi:10.1053/j.trap.2006.07.003

Cited by 3 publications

(7 citation statements)

References 22 publications

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“…Axillary brachial blocks were first performed by Hirschel in 1911 and have become increasingly popular given the safer profile when compared to other forms of brachial plexus anesthesia (Monkowski and Larese, ). In the axillary block the patient is positioned supine with the arm abducted at 90°, and the forearm flexed to a 90° angle.…”

Section: Axillary Blockmentioning

confidence: 99%

“…The skin should be shaved if necessary, cleaned, and the patient appropriately draped. Utilizing the index and middle fingers, the arterial pulse is palpated at the axillary surface adjacent to the upper border of the pectoralis major (De Jong and Rudolph, ; Monkowski and Larese, ). Once the pulse is identified, a 50 mm, 22‐gauge needle is inserted over the fingers toward the axillary apex at a 20‐ to 30° angle.…”

Section: Axillary Blockmentioning

confidence: 99%

“…Further confirmation of the needle's location can be obtained by needle aspiration. Aspiration of blood, for example, would indicate improper positioning of the needle (within a blood vessel) (De Jong and Rudolph, ; Brockway and Wildsmith, ; Monkowski and Larese, ). The needle is advanced until the patient experiences a paresthesia in the hand, and is followed by injection of local anesthetic (Monkowski and Larese, ).…”

Section: Axillary Blockmentioning

confidence: 99%

“…Aspiration of blood, for example, would indicate improper positioning of the needle (within a blood vessel) (De Jong and Rudolph, ; Brockway and Wildsmith, ; Monkowski and Larese, ). The needle is advanced until the patient experiences a paresthesia in the hand, and is followed by injection of local anesthetic (Monkowski and Larese, ). A second injection is made below the axillary pulse, as this ensures the spread of anesthetic into the perivascular sheath (Monkowski and Larese, ).…”

Section: Axillary Blockmentioning

confidence: 99%

See 3 more Smart Citations

Brachial plexus anesthesia: A review of the relevant anatomy, complications, and anatomical variations

et al. 2013

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The trend towards regional anesthesia began in the late 1800s when William Halsted and Richard Hall experimented with cocaine as a local anesthetic for upper and lower limb procedures. Regional anesthesia of the upper limb can be achieved by blocking the brachial plexus at varying stages along the course of the trunks, divisions, cords and terminal branches. The four most common techniques used in the clinical setting are the interscalene block, the supraclavicular block, the infraclavicular block, and the axillary block. Each approach has its own unique set of advantages and indications for use. The supraclavicular block is most effective for anesthesia of the mid-humerus and below. Infraclavicular blocks are useful for procedures requiring continuous anesthesia. Axillary blocks provide effective anesthesia distal to the elbow, and interscalene blocks are best suited for the shoulder and proximal upper limb. The two most common methods for localizing the appropriate nerves for brachial plexus blocks are nerve stimulation and ultrasound guidance. Recent literature on brachial plexus blocks has largely focused on these two techniques to determine which method has greater efficacy. Ultrasound guidance has allowed the operator to visualize the needle position within the musculature and has proven especially useful in patients with anatomical variations. The aim of this study is to provide a review of the literature on the different approaches to brachial plexus blocks, including the indications, techniques, and relevant anatomical variations associated with the nerves involved.

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Section: Axillary Blockmentioning

confidence: 99%

Section: Axillary Blockmentioning

confidence: 99%

Section: Axillary Blockmentioning

confidence: 99%

Section: Axillary Blockmentioning

confidence: 99%

See 2 more Smart Citations

Brachial plexus anesthesia: A review of the relevant anatomy, complications, and anatomical variations

et al. 2013

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“…Axillary nerve block is a safe and effective regional anaesthetic technique suitable for a wide variety of procedures, for both inpatient and outpatient care [27][28][29][30][31][32]. Ultrasound guidance has allowed improved efficacy with smaller volumes of local anaesthetic.…”

Section: Resultsmentioning

confidence: 99%

Axillary brachial plexus block

Warman¹,

Conn²,

Nicholls³

et al. 2014

Regional Anaesthesia, Stimulation, and Ultrasound Techniques

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The axillary approach to brachial plexus blockade provides satisfactory anaesthesia for elbow, forearm, and hand surgery and also provides reliable cutaneous anaesthesia of the inner upper arm including the medial cutaneous nerve of arm and intercostobrachial nerve, areas often missed with other approaches. In addition, the axillary approach remains the safest of the four main options, as it does not risk blockade of the phrenic nerve, nor does it have the potential to cause pneumothorax, making it an ideal option for day case surgery. Historically, single-injection techniques have not provided reliable blockade in the musculocutaneous and radial nerve territories, but success rates have greatly improved with multiple-injection techniques whether using nerve stimulation or ultrasound guidance. Complete, reliable, rapid, and safe blockade of the arm is now achievable, and the paper summarizes the current position with particular reference to ultrasound guidance.

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