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

Abstract

This review provides evidence that multiple-injection techniques using nerve stimulation for axillary plexus block produce more effective anaesthesia than either double or single-injection techniques. However, there was insufficient evidence to draw any definitive conclusions regarding differences in other outcomes, including safety.

Spread of Injectate After Combined Deep Serratus Anterior and Superficial Parasternal Intercostal Plane Injections: A Cadaver Study to Evaluate Their Utility in Breast Surgery

“…Multiple injections may sound daunting to some patients, as low patient satisfaction is most commonly related to discomfort during block placement and transient post‐operative pain when the effects of local anesthesia initially subside [ 24 ]. However, both routine clinical practice and several studies have overwhelmingly found that the use of multiple injections results in a greater success rate when compared to single‐injection techniques while also having a quicker onset and longer duration [ 25 , 26 ].…”

Spread of Injectate After Combined Deep Serratus Anterior and Superficial Parasternal Intercostal Plane Injections: A Cadaver Study to Evaluate Their Utility in Breast Surgery

“…Multiple injections may sound daunting to some patients, as low patient satisfaction is most commonly related to discomfort during block placement and transient post‐operative pain when the effects of local anesthesia initially subside [ 24 ]. However, both routine clinical practice and several studies have overwhelmingly found that the use of multiple injections results in a greater success rate when compared to single‐injection techniques while also having a quicker onset and longer duration [ 25 , 26 ].…”

A randomised, non-inferiority study of chloroprocaine 2% and ropivacaine 0.75% in ultrasound-guided axillary block

“…In the present study, ultrasound was used as per gold standard in all participating hospitals. Each one of the 4 nerves was visualized, identified and blocked separately—a technique, that has proven superior in comparison to single injection techniques, also according to a recent Cochrane analysis 18 . In this analysis, which included 22 trials, it was shown that higher success rates could be achieved with multiple injection techniques in comparison to single injection techniques.…”

Regional Anesthesia for Hand Surgeries

“…The block performance time with axillary block is relatively longer than with the supraclavicular and infraclavicular blocks due to the higher needling time [4,5]. Also multiple injection technique has higher success rate than single or double injection technique when a non-ultrasound-guided technique was used [6].…”

Spread of Injectate After Combined Deep Serratus Anterior and Superficial Parasternal Intercostal Plane Injections: A Cadaver Study to Evaluate Their Utility in Breast Surgery

“…Multiple injections may sound daunting to some patients, as low patient satisfaction is most commonly related to discomfort during block placement and transient post‐operative pain when the effects of local anesthesia initially subside [ 24 ]. However, both routine clinical practice and several studies have overwhelmingly found that the use of multiple injections results in a greater success rate when compared to single‐injection techniques while also having a quicker onset and longer duration [ 25 , 26 ].…”

A randomised, non-inferiority study of chloroprocaine 2% and ropivacaine 0.75% in ultrasound-guided axillary block

“…In the present study, ultrasound was used as per gold standard in all participating hospitals. Each one of the 4 nerves was visualized, identified and blocked separately—a technique, that has proven superior in comparison to single injection techniques, also according to a recent Cochrane analysis 18 . In this analysis, which included 22 trials, it was shown that higher success rates could be achieved with multiple injection techniques in comparison to single injection techniques.…”

Regional Anesthesia for Hand Surgeries

“…The block performance time with axillary block is relatively longer than with the supraclavicular and infraclavicular blocks due to the higher needling time [4,5]. Also multiple injection technique has higher success rate than single or double injection technique when a non-ultrasound-guided technique was used [6].…”

Spread of Injectate After Combined Deep Serratus Anterior and Superficial Parasternal Intercostal Plane Injections: A Cadaver Study to Evaluate Their Utility in Breast Surgery

“…Multiple injections may sound daunting to some patients, as low patient satisfaction is most commonly related to discomfort during block placement and transient post‐operative pain when the effects of local anesthesia initially subside [ 24 ]. However, both routine clinical practice and several studies have overwhelmingly found that the use of multiple injections results in a greater success rate when compared to single‐injection techniques while also having a quicker onset and longer duration [ 25 , 26 ].…”

A randomised, non-inferiority study of chloroprocaine 2% and ropivacaine 0.75% in ultrasound-guided axillary block

“…In the present study, ultrasound was used as per gold standard in all participating hospitals. Each one of the 4 nerves was visualized, identified and blocked separately—a technique, that has proven superior in comparison to single injection techniques, also according to a recent Cochrane analysis 18 . In this analysis, which included 22 trials, it was shown that higher success rates could be achieved with multiple injection techniques in comparison to single injection techniques.…”

Regional Anesthesia for Hand Surgeries

“…The block performance time with axillary block is relatively longer than with the supraclavicular and infraclavicular blocks due to the higher needling time [4,5]. Also multiple injection technique has higher success rate than single or double injection technique when a non-ultrasound-guided technique was used [6].…”