Perivascular axillary brachial plexus block and patient positioning: the influence of a lateral, head-down position.
The aim of this study was to examine the effect of a 20 degrees Trendelenburg position on the blockade of nerves that exit the brachial plexus proximally in patients undergoing single-injection axillary brachial plexus block. After a pilot study of eight cadavers suggested that a head-down and lateral position would encourage the proximal spread of local anaesthetic, 72 patients undergoing elective surgery were divided into two equal groups: a Supine group and a Modified Position group (lateral position, 20 degrees head-down tilt). Patients were left in the allocated position for 30 min after an axillary block had been performed with alkalinised mepivacaine 1% 49.5 ml. Sensory and motor blockade evaluation showed that there was a significantly higher proportion of axillary nerve (76% vs. 0%, p < 0.001), thoracodorsal nerve (86% vs. 0%, p < 0.001) and subscapular nerve (89% vs. 0%, p < 0.001) blockade in the Modified Position group. Sensory block of the radial nerve was also improved by the modified position (100% vs. 86%, p < 0.05).
Orlowski
O
O
Department of Anaesthesiology and Intensive Care, University of Münster, Germany. orlowski@anit.uni-muenster.de
Bullmann
V
V
Vieth
V
V
Filler
T
T
Osada
N
N
Van Aken
H
H
Weber
T P
TP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000493:pharmacokinetics; D001132:Arm / Q000601:surgery; D001917:Brachial Plexus; D003287:Contrast Media / Q000493:pharmacokinetics; D005260:Female; D018475:Head-Down Tilt; D006801:Humans; D008297:Male; D008619:Mepivacaine / Q000493:pharmacokinetics; D008875:Middle Aged; D009068:Movement / Q000187:drug effects; D009407:Nerve Block / Q000379:methods*; D013902:Radiography, Thoracic; D012677:Sensation / Q000187:drug effects; D016683:Supine Position; D013909:Thorax / Q000378:metabolism; D014057:Tomography, X-Ray Computed
D000779:Anesthetics, Local; D003287:Contrast Media; D008619:Mepivacaine