Canadian Journal of Anesthesia

, Volume 46, Issue 7, pp 658–664

Low dose axillary block by targeted injections of the terminal nerves

  • Zbigniew J. Koscielniak-Nielsen
  • Per Rotbøll Nielsen
  • Tommy Sørensen
  • Michael Stenør
Reports of Investigation

Abstract

Purpose

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 μg·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 TP < 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·kg−1 (2.4–5.6) in T group and 12.0 mg·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 TP < 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.

Résumé

Objectif

Comparer la durée de l’anesthésie, le taux de succès et les effets indésirables à la suite d’un blocage axillaire au moyen d’injections uniques ou multiples d’anesthésique local.

Méthode

Les patients ont été répartis en deux groupes: dans le groupe C (injections ciblées, n = 53), les quatre nerfs terminaux ont été localisés par stimulation électrique et insensibilisés avec 5 ml de mépivacaïne 1 % et 5 μg·ml−1 d’épinéphrine (MEPE); dans le groupe U (injection unique, n = 53), 80 ml de MEPE 1 % ont été injectés dans la gaine neurovasculaire, de façon transartérielle ou après avoir provoqué la paresthésie. Les blocages parcellaires ont été complétés après 30 min. Le patient était prêt pour l’opération quand l’analgésie était présente dans toutes les aires distales au coude.

Résultats

Le blocage a été complet après 11 min (6–15) dans le groupe C et 7 min (5–13) dans le groupe U, P < 0,01. Ladministration d’un supplément a été nécessaire chez 46% des patients du groupe U et 13 % du groupe C,P < 0,001: la durée de l’anesthésie a été de 32 min (19–52) dans le groupe C, et de 39 min (16–58) dans le groupe U, P = 0,02. Les doses moyennes de MEPE ont été de 3,5 μg·ml−1 (2,4–5,6) dans le groupe C et de 12,0 μg·ml−1 (8,9–16,4), dans le groupe U. Toutefois, 22 % des patients du groupe C et 4 % du groupe U se sont plaints de douleur liées au garrot,P = 0,02. La paresthésie a été provoquée chez 42% des patients du groupe U et 8 % du groupe C,P < 0,001.

Conclusion

Des doses faibles et ciblées de MEPE réduisent la durée totale de l’anesthésie, fournissent une plus grande étendue de l’analgésie dans la main et l’avant-bras et peuvent être plus sûres que l’injection unique d’une forte dose.

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Copyright information

© Canadian Anesthesiologists 1999

Authors and Affiliations

  • Zbigniew J. Koscielniak-Nielsen
    • 1
  • Per Rotbøll Nielsen
    • 1
  • Tommy Sørensen
    • 1
  • Michael Stenør
    • 1
  1. 1.Department of Anaesthesia and Intensive CareNational University HospitalCopenhagen ØDenmark

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