Ultrasound-Guided Anaesthesia of the Axillary Brachial plexus: Efficacy of Multiple Injection Approach

Schwemmer, Ulrich; Ck, Markus; Ca, Greim; Brederlau, Joerg; Roewer, N.

doi:10.1055/s-2005-858071

Cited by 48 publications

(25 citation statements)

References 15 publications

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“…Schwemmer et al 15 reported complete anesthesia of the brachial plexus with fast onset following ultrasound guided axillary block in 46 patients. Among published comparative studies to date, most were small scaled, and failed to show improved block success with ultrasound based on assessment of surgical anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound guidance improves success rate of axillary brachial plexus block

Chan

Perlas

McCartney

et al. 2007

Can J Anesth/J Can Anesth

344

168

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Purpose: The purpose of this study is to determine if real time ultrasound guidance improves the success rate of axillary brachial plexus blockade. Methods:Patients undergoing elective hand surgery were randomly assigned to one of three groups. Axillary blocks were performed using three motor response endpoints in the nerve stimulator (NS) Group, real-time ultrasound guidance in the ultrasound (US) Group and combined ultrasound and nerve stimulation in the USNS Group. Following administration of a standardized solution containing 2% lidocaine with 1:200,000 epinephrine and 0.5% bupivacaine (total 42 mL), sensory and motor functions were assessed by a blinded observer every five minutes for 30 min. A successful block was defined as complete sensory loss in the median, radial and ulnar nerve distribution by 30 min. The need for local and general anesthesia supplementation and post-block adverse events were documented. Results:One hundred and eighty-eight patients completed the study. Block success rate was higher in Groups US and USNS (82.8% and 80.7%) than Group NS (62.9%) (P = 0.01 and 0.03 respectively). Fewer patients in Groups US and USNS required supplemental nerve blocks and/or general anesthesia. Postoperatively, axillary bruising and pain were reported more frequently in Group NS. Conclusion: This study demonstrates that ultrasound guidance, with or without concomitant nerve stimulation, significantly improves the success rate of axillary brachial plexus block. EG et EGNS (82,8 % et 80,7 %) que dans le groupe NS (62,9 %) (P = 0,01 et 0,03 respectivement Méthode : Des patients devant subir une chirurgie élective de la main ont été randomisés en trois groupes. Des blocs axillaires ont été effectués en utilisant : trois points de réponses motrices dans le groupe neurostimulateur (NS), l'échoguidage en temps réel dans le groupe échographie (EG), et l'échographie combinée à la stimulation nerveuse dans le troisième groupe (EGNS

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Section: Discussionmentioning

confidence: 99%

Ultrasound guidance improves success rate of axillary brachial plexus block

Chan

Perlas

McCartney

et al. 2007

Can J Anesth/J Can Anesth

344

168

View full text Add to dashboard Cite

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“…Schwemmer et al [15,16] stated that ultrasonography application significantly increases the success rate of axillary blocks and that starting time of operation following the block is much earlier. Throughout our study, we detected that sensory block started earlier in the ultrasonography-applied group although this was not singnificant statistically and on the other hand, that motor block rate in this group was significantly higher in comparison with the other group.…”

Section: Discussionmentioning

confidence: 99%

Comparision of Nerve Stimulator and Ultrasonography as the techniques applied for Brachial Plexus Anesthesia.

Zencirci¹

2011

Int Arch Med

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BackgroundBrachial plexus block is useful for upper extremity surgery, and many techniques are available. The aim of our study was to compare the efficacy of axillary brachial plexus block using an ultrasound technique to the peripheral nerve stimulation technique.Methods60 patients scheduled for surgery of the forearm or hand were randomly allocated into two groups (n = 30 per group). For Group 1; US, and for Group 2 PNS was applied. The quality and the onset of the sensorial and motor blockade were assessed. The sensorial blockade, motor blockade time and quality of blockade were compared among the cases.ResultsThe time needed to perform the axillary brachial plexus block averaged is similar in both groups (p > 0.05). Although not significant statistically, it was observed that the sensory block had formed earlier in Group 1 (p > 0.05). But the degree of motor blockade was intenser in Group 1 than in Group 2 (p < 0.05).ConclusionsUltrasound offers a new possibility for identifiying the nerves of the brachial plexus for regional anesthesia. The ultrasound-guided axillary brachial plexus block is a safe method with faster onset time and better quality of motor blockade compared to peripheral nerve stimulation technique.

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“…An alternative study by Casati et al [12] however, could not demonstrate this improved success rate. Benefits of the use of ultrasound are the reduced need for nerve stimulation with improved patient comfort [12], reduced volume of local anesthetics used [13–16], and shortened onset time [10, 17]. In this retrospective study focussing on learning of the skills, we found that ultrasound-guided axillary brachial plexus block when performed by junior residents is learned faster and with a higher success rate compared to nerve stimulator-guided axillary brachial plexus blocks.…”

Section: Discussionmentioning

confidence: 99%

Different Learning Curves for Axillary Brachial Plexus Block: Ultrasound Guidance versus Nerve Stimulation

Luyet

Schüpfer

Wipfli

et al. 2010

Anesthesiology Research and Practice

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Little is known about the learning of the skills needed to perform ultrasound- or nerve stimulator-guided peripheral nerve blocks. The aim of this study was to compare the learning curves of residents trained in ultrasound guidance versus residents trained in nerve stimulation for axillary brachial plexus block. Ten residents with no previous experience with using ultrasound received ultrasound training and another ten residents with no previous experience with using nerve stimulation received nerve stimulation training. The novices' learning curves were generated by retrospective data analysis out of our electronic anaesthesia database. Individual success rates were pooled, and the institutional learning curve was calculated using a bootstrapping technique in combination with a Monte Carlo simulation procedure. The skills required to perform successful ultrasound-guided axillary brachial plexus block can be learnt faster and lead to a higher final success rate compared to nerve stimulator-guided axillary brachial plexus block.

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Ultrasound-Guided Anaesthesia of the Axillary Brachial plexus: Efficacy of Multiple Injection Approach

Abstract: Performing axillary nerve blockade using ultrasound guidance provides excellent anaesthesia and fast onset times.

Cited by 48 publications

References 15 publications

Ultrasound guidance improves success rate of axillary brachial plexus block

Ultrasound guidance improves success rate of axillary brachial plexus block

Comparision of Nerve Stimulator and Ultrasonography as the techniques applied for Brachial Plexus Anesthesia.

Different Learning Curves for Axillary Brachial Plexus Block: Ultrasound Guidance versus Nerve Stimulation

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