title: Comparison of ultrasound-guided axillary brachial plexus block techniques: perineural injection versus single or double perivascular infiltration.
abstract: OBJECTIVE
  We compared three methods of ultrasound-guided axillary brachial plexus block, which were single, and double perivascular (PV) infiltration techniques, and a perineural (PN) injection technique.
  
  
  METHODS
  78 patients of American Society of Anesthesiologists physical status I-II undergoing surgery of the forearm, wrist, or hand were randomly allocated to three groups. 2% lidocaine with epinephrine 5 μg/mL was used. The PN group (n=26) received injections at the median, ulnar, and radial nerve with 8 mL for each nerve. The PV1 group (n=26) received a single injection of 24 mL at 12-o'clock position of the axillary artery. The PV2 group (n=26) received two injections of 12 mL each at 12-o'clock and 6-o'clock position. For all groups, musculocutaneous nerve was blocked separately.
  
  
  RESULTS
  The PN group (391.2±171.6 sec) had the longest anesthetic procedure duration than PV1 (192.8±59.0 sec) and PV2 (211.4±58.6 sec). There were no differences in onset time. The average induction time was longer in PN group (673.4±149.6 sec) than PV1 (557.6±194.9 sec) and PV2 (561.5±129.8 sec). There were no differences in the success rate (89.7% vs. 86.2% vs. 89.7%).
  
  
  CONCLUSIONS
  The PV injection technique consisting of a single injection in 12-o'clock position above the axillary artery in addition to a musculocutaneous nerve block is equally effective and less time consuming than the PN technique. Therefore, the PV technique is an alternative method that may be used in busy clinics or for difficult cases.
authors.affiliation: Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
authors.forename: Sooyoung
authors.initials: S
authors.lastname: Cho
authors.affiliation: Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea. ankyj@ewha.ac.kr.
authors.forename: Youn Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Baik
authors.affiliation: Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
authors.forename: Jong Hak
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Woo
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D001917:Brachial Plexus / Q000000981:diagnostic imaging* / Q000187:drug effects*; D065527:Brachial Plexus Block / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005542:Forearm / Q000601:surgery; D006225:Hand / Q000601:surgery; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D010525:Peripheral Nerves / Q000000981:diagnostic imaging; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D034941:Upper Extremity / Q000294:innervation / Q000601:surgery*; D057772:Vascular System Injuries / Q000209:etiology; D014953:Wrist / Q000601:surgery
chemical_list: D000779:Anesthetics, Local
keywords: Brachial plexus; nerve block; ultrasonography
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