Single, double or multiple-injection techniques for non-ultrasound guided axillary brachial plexus block in adults undergoing surgery of the lower arm

Chin, Ki Jinn; Alakkad, Husni; Cubillos, Javier

doi:10.1002/14651858.cd003842.pub4

Cited by 9 publications

(7 citation statements)

References 43 publications

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“…The 92% rate of successful blockade in our metaanalysis is higher than previously described, despite injecting 20-35 ml of local anaesthetic compared with 40-50 ml used in trials of axillary brachial plexus blocks without ultrasound [3] and infraclavicular brachial plexus block with or without ultrasound [46], which reported success rates of 76% and 88%, respectively. It is likely that ultrasound guidance allows a more accurate and efficient deposition of perineural local anaesthetic [5,47,48].…”

Section: Discussioncontrasting

confidence: 69%

“…A single injection was as effective as multiple injections and took less time and caused less paraesthesia. Multiple injections were more effective than a single injection in a recent systematic of axillary brachial plexus blocks performed without ultrasound [3], which suggested that plexus location using anatomical landmarks, paraesthesia or nerve stimulation was inaccurate. It has been suggested that septae might prevent the flow of local anaesthetic around all nerves in a plexus [43].…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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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Section: Discussioncontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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“…Chin et al . also conducted a Cochrane systematic review on axillary plexus block, assessing single, double, and multiple injection techniques 23 . In all, 21 trials were included, presenting results from a total of 2148 participants who received regional anaesthesia for hand, wrist, forearm, or elbow surgery.…”

Section: Efficacy and Outcomementioning

confidence: 99%

Upper extremity nerve block: how can benefit, duration, and safety be improved? An update

et al. 2016

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Upper extremity blocks are useful as both sole anaesthesia and/or a supplement to general anaesthesia and they further provide effective postoperative analgesia, reducing the need for opioid analgesics. There is without doubt a renewed interest among anaesthesiologists in the interscalene, supraclavicular, infraclavicular, and axillary plexus blocks with the increasing use of ultrasound guidance. The ultrasound-guided technique visualising the needle tip and solution injected reduces the risk of side effects, accidental intravascular injection, and possibly also trauma to surrounding tissues. The ultrasound technique has also reduced the volume needed in order to gain effective block. Still, single-shot plexus block, although it produces effective anaesthesia, has a limited duration of postoperative analgesia and a number of adjuncts have been tested in order to prolong analgesia duration. The addition of steroids, midazolam, clonidine, dexmedetomidine, and buprenorphine has been studied, all being off-label when administered by perineural injection, and the potential neurotoxicity needs further study. The use of perineural catheters is an effective option to improve and prolong the postoperative analgesic effect. Upper extremity plexus blocks have an obvious place as a sole anaesthetic technique or as a powerful complement to general anaesthesia, reducing the need for analgesics and hypnotics intraoperatively, and provide effective early postoperative pain relief. Continuous perineural infusion is an effective option to prolong the effects and improve postoperative quality.

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“…This supports the established recommendation to use multiple injections when performing axillary blocks. 11 …”

Section: Discussionmentioning

confidence: 99%

MRI of axillary brachial plexus blocks

Kjelstrup

Hol²,

Courivaud³

et al. 2014

European Journal of Anaesthesiology

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BACKGROUNDAxillary plexus blocks are usually guided by ultrasound, but alternative methods may be used when ultrasound equipment is lacking. For a nonultrasound-guided axillary block, the need for three injections has been questioned.OBJECTIVESCould differences in block success between single, double and triple deposits methods be explained by differences in local anaesthetic distribution as observed by MRI?DESIGNA blinded and randomised controlled study.SETTINGConducted at Oslo University Hospital, Rikshospitalet, Norway from 2009 to 2011.PATIENTSForty-five ASA 1 to 2 patients scheduled for surgery were randomised to three equally sized groups. All patients completed the study.INTERVENTIONSPatients in the single-deposit group had an injection through a catheter parallel to the median nerve. In the double-deposit group the patients received a transarterial block. In the triple-deposit group the injections of the two other groups were combined. Upon completion of local anaesthetic injection the patients were scanned by MRI, before clinical block assessment. The distribution of local anaesthetic was scored by its closeness to terminal nerves and cords of the brachial plexus, as seen by MRI. The clinical effect was scored by the degree of sensory block in terminal nerve innervation areas.MAIN OUTCOME MEASURESSensory block effect and MRI distribution pattern.RESULTSThe triple-deposit method had a higher success rate (100%) than the single-deposit method (67%) and the double-deposit method (67%) in blocking all cutaneous nerves distal to the elbow (P = 0.04). The patients in the triple-deposit group most often had the best MRI scores. For any nerve or cord, at least one of the single-deposit or double-deposit groups had a similarly high MRI score as the triple-deposit group.CONCLUSIONDistal to the elbow, the triple-deposit method had the highest sensory block success rate. This could be explained to some extent by analysis of the magnetic resonance images.TRIAL REGISTRATIONClinicalTrials.gov identifier: NCT01033006.

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Single, double or multiple-injection techniques for non-ultrasound guided axillary brachial plexus block in adults undergoing surgery of the lower arm

Cited by 9 publications

References 43 publications

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

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

Upper extremity nerve block: how can benefit, duration, and safety be improved? An update

MRI of axillary brachial plexus blocks

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