title: Ultrasound-guided anaesthesia of the axillary brachial plexus: efficacy of multiple injection approach.
abstract: OBJECTIVE
  High resolution ultrasound is a new method for detecting anatomical structures in the axilla. The visualisation of nerves can improve the quality of nerve blocks. The aim of our study was to investigate the feasibility of hand held ultrasound to perform sonographically guided blockades of the axillary plexus.
  
  
  METHODS
  We investigated 46 patients routinely scheduled for forearm and hand surgery (ASA physical status I-IV, age range 19 - 89 years, mean 47). The axilla was examined using a handheld ultrasound system with a 10 MHz linear array probe. The median, ulnar, radial and musculocutaneus nerve were visualised by ultrasound. Selective nerve blockade was performed under sonographic guidance. Real time monitoring of the local anaesthetic spread was performed. Time required to perform the block and onset times of anaesthesia were documented.
  
  
  RESULTS
  Complete anaesthesia of the brachial plexus was achieved in all cases. The average time to perform the block was 5 minutes (SD 2 min). Onset time for the block was 7 minutes (SD 3 min).
  
  
  CONCLUSIONS
  Performing axillary nerve blockade using ultrasound guidance provides excellent anaesthesia and fast onset times.
authors.affiliation: Department of Anaesthesiology, University Hospital Würzburg, Germany. Schwemmer_U@klinik.uni-wuerzburg.de
authors.forename: U
authors.initials: U
authors.lastname: Schwemmer
authors.forename: C K
authors.initials: CK
authors.lastname: Markus
authors.forename: C-A
authors.initials: CA
authors.lastname: Greim
authors.forename: J
authors.initials: J
authors.lastname: Brederlau
authors.forename: N
authors.initials: N
authors.lastname: Roewer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001917:Brachial Plexus / Q000000981:diagnostic imaging*; D006225:Hand / Q000601:surgery; D006801:Humans; D008475:Median Nerve / Q000000981:diagnostic imaging; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009407:Nerve Block / Q000379:methods*; D011826:Radial Nerve / Q000000981:diagnostic imaging; D019651:Plastic Surgery Procedures; D014459:Ulnar Nerve / Q000000981:diagnostic imaging; D014463:Ultrasonography