[Ultrasound-guided blockade of axillary plexus brachialis for hand surgery].
OBJECTIVE
Blockade of the axillary plexus brachialis is an integral part of the anesthetic-specific procedures in the field of hand surgery. Less side-effects with high success rates are demanded of the surgeons and required by the patients. Normally, blockade of the axillary plexus brachialis is performed by using nerve stimulation. An alternative technique described here as a retrospective study uses ultrasound for detection of the nerves.


METHODS
At the level of axilla, anatomical structures (axillary vein and artery, triceps/coracobrachialis muscles, ulnar/radial/median nerves) were visualized by ultrasound (linear scanner, 10-MHz transducer). At this position, a puncture needle was inserted into the nerves and local anesthetics were injected (50 ml prilocaine 1 % or 40 prilocaine 1 % and 20 ropivacaine 0.5 %). Parameters like onset time of blockade (min), complete block (yes/no) and possible complications were documented.


RESULTS
In 30 months 221 ultrasound-guided blocks of axillary plexus brachialis were performed by eight anesthetists with different levels of training. In 96.8 % of the documented cases blockade was complete and did not require any supplementation. Only in seven cases was a conversion of the anesthetic technique performed. Adverse effects like toxic-allergic reactions or nerve damage caused by the punctures were not documented in any case. The average time to onset of the blockade was 2.2 minutes.


CONCLUSIONS
Ultrasound-guided blockade of the axillary plexus brachialis represents an alternative to procedures using nerve stimulation, even in patients with anatomic abnormalities. The described method proved to be effective, especially in the field of hand surgery.
Kefalianakis
F
F
Klinik für Anästhesiologie, Interdisziplinäre Intensivmedizin und Schmerztherapie, Klinikum Ludwigsburg. Fotios.Kefalianakis@kliniken-lb.de
Spohner
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001917:Brachial Plexus / Q000000981:diagnostic imaging*; D002648:Child; D005260:Female; D006225:Hand / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D014463:Ultrasonography