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. 2017 Jun;45(3):164-168.
doi: 10.5152/TJAR.2017.33349. Epub 2017 Feb 1.

Importance of the Upper Extremity Position for a Safe and Effective Axillary Block: a Comparative Study

Ömür Öztürk  1 , Aysu Hayriye Tezcan  1 , Ali Bilge  2 , Esref Erdem  1 , Hatice Yağmurdur  1 , Burhan Dost  3
Affiliations

Importance of the Upper Extremity Position for a Safe and Effective Axillary Block: a Comparative Study

Ömür Öztürk et al. Turk J Anaesthesiol Reanim. 2017 Jun.

Abstract

Objective: Our aim was to determine the ideal position of upper extremities during ultrasonography guidance for axillary block. The position that provides the shortest distance between the median and musculocutaneous nerves was assumed to be the most appropriate position for axillary block.

Methods: In this cross-sectional study, 120 (45 female and 75 male) patients were placed in a position with a shoulder at 90° / elbow 90° (position 1) and a shoulder 90° / elbow 0° (position 2). The intersection point of the biceps brachii muscle with the lower border of the pectoralis major muscle is defined as the proximal level (P). Distal level (D) is reffered as 5 cm below the proximal level. In the positions described above, the distance between median and musculocutaneous nerves was measured proximal (positions 1P and 2P) and distal levels (positions 1D and 2D). It was investigated whether these measurements differed between the groups and whether the body mass index or the gender.

Results: The shortest mean distance (10.24±3.95 mm) between the two nerves was determined when the shoulder position 90°/elbow position 0° at the distal level (1D) and the longest mean distance (13.41±4.26 mm) was determined when shoulder position 90°/elbow position 90° at the proximal level (2P). In all four cases, there was no difference in the results between men and women. There was no relationship between the measurement results and the body mass indexes and age of the patients.

Conclusion: Appropriate positioning of the upper extremities is important for achieving optimal position during axillary block. Thereby, the procedure can be safely and effectively performed with lesser amounts of local anaesthetic solution and a decreased number of manoeuvres with needle during infiltration.

Keywords: Axillary block; median nerve; musculocutaneous nerve; ultrasound guidance.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
Ultrasonic view of axilla in the proximal position. The median and musculocutaneous nerves were marked
Figure 2
Figure 2
Ultrasonic view of axilla in the distal position. The median and musculocutaneous nerves were marked
See this image and copyright information in PMC

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