Low dose axillary block by targeted injections of the terminal nerves.
OBJECTIVE
To compare anesthetic time, success rate and adverse effects of axillary block by single or multiple injections of local anesthetic.


METHODS
Two groups of patients were studied. In group T (targeted injections, n = 53) the four terminal nerves were located by electrical stimulation, and anesthetized with 5 ml mepivacaine 1% with epinephrine 5 microg x ml(-1) (MEPE). In group S (single injection, n = 53) 80 mL MEPE 1% were injected into the neurovascular sheath, transarterially or after eliciting paresthesia. Patchy blocks were supplemented after 30 min. The patient was ready for surgery when analgesia was present in all areas distal to the elbow.


RESULTS
The block was complete at 11 min (6-15) in Group T and 7 min (5-13) in group S, P<0.01. Supplementation was required in 46% in group S compared with 13% in group T P<0.001: anesthesia time was 32 min (19-52) in group T, and 39 min (16-58) in group S, P = 0.02. The average doses of MEPE were 3.5 mg x kg(-1) (2.4-5.6) in T group and 12.0 mg x kg(-1) (8.9-16.4), in S group. However, 22% of patients in group T and 4% in group S reported tourniquet pain, P = 0.02. Paresthesia was elicited in 42% of patients in group S and 8% in group T, P<0.001.


CONCLUSIONS
Small targeted injections of MEPE reduce total anesthetic time, give better spread of analgesia in the hand and forearm, and may be safer than a single large injection.
Koscielniak-Nielsen
Z J
ZJ
Department of Anaesthesia and Intensive Care, National University Hospital, Rigshospitalet AN 4132, Copenhagen, Denmark. zjkn@rh.dk
Rotbøll Nielsen
P
P
Sørensen
T
T
Stenør
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008619:Mepivacaine / Q000008:administration & dosage*; D008875:Middle Aged; D009407:Nerve Block; D013997:Time Factors
D000779:Anesthetics, Local; D008619:Mepivacaine; D004837:Epinephrine