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. 2014 Nov-Dec;58(6):700-4.
doi: 10.4103/0019-5049.147138.

Comparison of peripheral nerve stimulator versus ultrasonography guided axillary block using multiple injection technique

Alok Kumar  1 , Dk Sharma  1 , Maj E Sibi  2 , Barun Datta  3 , Biraj Gogoi  3
Affiliations

Comparison of peripheral nerve stimulator versus ultrasonography guided axillary block using multiple injection technique

Alok Kumar et al. Indian J Anaesth. 2014 Nov-Dec.

Abstract

Background: The established methods of nerve location were based on either proper motor response on nerve stimulation (NS) or ultrasound guidance. In this prospective, randomised, observer-blinded study, we compared ultrasound guidance with NS for axillary brachial plexus block using 0.5% bupivacaine with the multiple injection techniques.

Methods: A total of 120 patients receiving axillary brachial plexus block with 0.5% bupivacaine, using a multiple injection technique, were randomly allocated to receive either NS (group NS, n = 60), or ultrasound guidance (group US, n = 60) for nerve location. A blinded observer recorded the onset of sensory and motor blocks, skin punctures, needle redirections, procedure-related pain and patient satisfaction.

Results: The median (range) number of skin punctures were 2 (2-4) in group US and 3 (2-5) in group NS (P < 0.001). No differences were observed in the onset of sensory block in group NS (6.17 ± 1.22 min) and in group US (6.33 ± 0.48 min) (P = 0.16), and in onset of motor block (23.33 ± 1.26 min) in group US and (23.17 ± 1.79 min) in group NS; P > =0.27). Insufficient block was observed in three patient (5%) of group US and four patients (6.67%) of group NS (P > =0.35). Patient acceptance was similarly good in the two groups.

Conclusion: Multiple injection axillary blocks with ultrasound guidance provided similar success rates and comparable incidence of complications as compared with NS guidance with 20 ml 0.5% bupivacaine.

Keywords: Axillary block; multiple injection techniques; peripheral nerve stimulator.

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Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
Axillary block and the anatomical localisation of nerves around axillary artery. AA – Axillary artery; AV – Axillary vein; MN – Median nerve; UN – Ulnar nerve; RN – Radial nerve; CBM – Coracobrachialis; MCN – Musculocutaneous nerve
Figure 2
Figure 2
Colour Doppler with visualisation of axillary artery, vein and the location of nerves around the vessel. Also visualised is musculocutaneous nerve in the plane between biceps and coracobrachialis muscle. AA – -Axillary artery;, AV – -Axillary vein;, M-Median nerve; U – -Ulnar nerve; R-Radial nerve; MCN – -Musculocutaneous nerve
See this image and copyright information in PMC

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