Complications of Brachial Plexus Anesthesia

  • Brendan T. Finucane
  • Ban C. H. Tsui

Abstract

In 1884, Carl Köller1 discovered the local anesthetic properties of cocaine while working with Sigmund Freud. This was one of the most important discoveries in the history of medicine. In that very same year, Halsted2 performed the first documented case of brachial plexus anesthesia at Johns Hopkins hospital when he injected the brachial plexus in the supraclavicular region under direct vision. The first percutaneous approach to the brachial plexus was performed by Hirschel3 in 1911, when he injected local anesthetic drugs into the axillary sheath. In that same year, Kulenkampff4 described the classic supraclavicular approach to the brachial plexus. Axillary approaches to the brachial plexus have always been more popular than supraclavicular techniques, perhaps because the risks seemed to be fewer.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Köller C. History of cocaine as a local anesthetic. JAMA 1941;117:1284–1285.Google Scholar
  2. 2.
    Halsted WS. Surgical papers. In: Burket WC, ed. 1st ed. Baltimore: Johns Hopkins Press; 1925.Google Scholar
  3. 3.
    Hirschel G. Anasthesierung des plexus brachialis bei Operationen an der oberen extremitat. Muenchener Medizinische Wochenschrift 1911;58:1555–1556.Google Scholar
  4. 4.
    Kulenkampff D. Anesthesia of the brachial plexus [German]. Zentralb Chir 1911;38:1337–1340.Google Scholar
  5. 5.
    Ting PL, Sivagnanratnam V. Ultrasonographic study of the spread of local anesthetic during axillary brachial plexus block. Br J Anaesth 1989;63:326–329.PubMedGoogle Scholar
  6. 6.
    Kopral S, Krafft P, Eibenberger K, et al. Ultrasound-guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesth Analg 1994;78:503–507.Google Scholar
  7. 7.
    Williams SR, Chouinard P, Arcind G, et al. Ultrasound guidance speeds execution and improves quality of supraclavicular block. Anesth Analg 2003;97:1518–1523.PubMedGoogle Scholar
  8. 8.
    Kroll DA, Caplan RA, Posner K. Nerve injury associated with anaesthesia. Anaesthesiology 1990;73:202–207.Google Scholar
  9. 9.
    Kozody B, Ready LB, Barsa JE, et al. Dose requirement of local anaesthetic to produce grand mal seizure during stellate ganglion block. Can Anaesth Soc J 1982;29:489–491.PubMedGoogle Scholar
  10. 10.
    Auroy Y, Narchi P, Messiah A, et al. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology 1997;87:479–486.PubMedGoogle Scholar
  11. 11.
    Brown DL, Ransom DM, Hall JA, et al. Regional anaesthesia and local anesthetic — induced systemic toxicity: seizure frequency and accompanying cardiovascular changes. Anesth Analg 1995;81:321–328.PubMedGoogle Scholar
  12. 12.
    Plevak DJ, Lindstromberg J W, Danielson DR. Paresthesia vs non-paresthesia — the axillary block [abstract]. Anaesthesiology 1983;59:A216.Google Scholar
  13. 13.
    Finucane BT, Zaman N, Kashkari I, et al. The dose of lidocaine selected for axillary blocks should not be based on body weight in adults [abstract]. Can J Anaesth 1998:A47B.Google Scholar
  14. 14.
    Finucane BT, Zaman N, Tawfik S, et al. Influence of age on the uptake of lidocaine from the axillary space [abstract]. 4th American-Japanese Congress. San Francisco; 1997.Google Scholar
  15. 15.
    Winnie AP, Hakansson L, Buckhoj P. Plexus Anaesthesia Perivascular Techniques of Brachial Plexus Block. Philadelphia: WB Saunders; 1983.Google Scholar
  16. 16.
    Canadian Pharmaceutical Association. Compendium of Pharmaceuticals and Specialties CPS. 29th ed. Toronto; 1994.Google Scholar
  17. 17.
    Rosenberg PH, Veering PD, Urmey WF. Maximum recommended doses of local anesthetics: a multifactorial concept. Reg Anesth Pain Med 2004;29:564–575.PubMedGoogle Scholar
  18. 18.
    Covino BG, Vassallo HG. Local Anesthetics: Mechanisms of Action and Clinical Use. New York: Grune & Stratton; 1976.Google Scholar
  19. 19.
    Cockings E, Moore PL, Lewis RC. Transarterial brachial plexus blockade using high doses of 1.5% mepivacaine. Reg Anesth 1987;12:159–164.Google Scholar
  20. 20.
    Finucane BT, Yilling F. Safety of supplementing axillary brachial plexus blocks. Anesthesiology 1989;70:401–403.PubMedGoogle Scholar
  21. 21.
    Urmey WF, Stanton J, Sharrock NE. Interscalene block. Effects of dose volume and mepivacaine concentrations on anesthesia and plasma levels [abstract]. Reg Anesth 1994;19:34.Google Scholar
  22. 22.
    Pälve H, Kirvela O, Olin H, et al. Maximum recommended doses of lidocaine are not toxic. Br J Anaesth 1995;74:704–705.PubMedGoogle Scholar
  23. 23.
    Büttner J, Klose R, Argo A. Serum levels of mepivacaine — HCl during continuous axillary plexus block: a prospective evaluation of 1,133 cases. Reg Anesth 1989;14:124–127.Google Scholar
  24. 24.
    Covino BG, Scott DB. Handbook of Epidural Anesthesia and Analgesia. New York: Grune & Stratton; 1985.Google Scholar
  25. 25.
    Jokinen M. Effects of drug interactions and liver disease on the pharmacokinetics of ropivacaine [PhD thesis]. University of Helsinki, Finland; 2003.Google Scholar
  26. 26.
    Gould DB, Aldrete JA. Bupivacaine cardiotoxicity in a patient with renal failure. Acta Anaesthesiol Scand 1983;27:18–21.PubMedGoogle Scholar
  27. 27.
    Tuominen M, Haasio J, Hekali R, et al. Continuous interscalene brachial plexus block. Clinical efficacy, technical problems and bupivacaine plasma concentration. Acta Anaesthesiol Scand 1989;33:84–88.PubMedGoogle Scholar
  28. 28.
    Norio K, Mäkisalo H, Isonemi H, et al. Are diabetic patients in danger at renal transplantation? An invasive perioperative study. Eur J Anaesthesiol 2000;17:729–736.PubMedGoogle Scholar
  29. 29.
    Pere P, Salonen M, Jokinen M, et al. Pharmacokinetics of ropivacaine in uremic and nonuremic patients after axillary brachial plexus block. Anesth Analg 2002;96:563–569.Google Scholar
  30. 30.
    Wald-Oboussier G, Vieil B, Biscoping J, et al. Die Wirkung von Bupavacain-HCL nach Supraklavikulärer Plexusblockade bei Patienten mit chronis eher Niereninsuffizienz. Reg Anaesth 1988;11:65–70.PubMedGoogle Scholar
  31. 31.
    Bowdle TA, Freund PR, Slattery JT. Age-dependent lidocaine pharmacokinetics during lumbar peridural anesthesia with lidocaine hydrocarbonate and lidocaine hydrochloride. Reg Anaesth 1986;11:123–127.Google Scholar
  32. 32.
    Kurokawa K, Mimori Y, Tanaka E, et al. Age-related change in peripheral nerve conduction: compound action potential duration and dispersion. Gerontology 1999;45:168–173.PubMedGoogle Scholar
  33. 33.
    Igarashi T, Hirabayashi Y, Shimizu R, et al. The lumbar extradural structure changes with increasing age. Br J Anaesth 1997;78:149–152.PubMedGoogle Scholar
  34. 34.
    Finucane BT, Hammonds WD, Welch MB. Influence of age on the vascular absorption of lidocaine from the epidural space. Anesth Analg 1987;66:843–846.PubMedGoogle Scholar
  35. 35.
    Butterworth JF, Walker FO, Lysak SZ. Pregnancy increases median nerve susceptibility to lidocaine. Anesthesiology 1990;72:962–965.PubMedGoogle Scholar
  36. 36.
    Pihlajamäki K, Kanto J, Lindberg R, et al. Extradural administration of bupivacaine: pharmacokinetics and metabolism in pregnant and non-pregnant women. Br J Anaesth 1990;64:556–562.PubMedGoogle Scholar
  37. 37.
    Santos AC, Pederson H, Harmon TW, et al. Does pregnancy alter the systemic toxicity of local anesthetics? Anesthesiology 1989;70:991–995.PubMedGoogle Scholar
  38. 38.
    Brownridge P, Cohen SE, Ward ME. Neural blockade for obstetric and gynecologic surgery. In: Cousins MJ, Bridenbough PO, eds. Neural Blockade in Clinical Anesthesia and Management of Pain. Philadelphia: Lippincott-Raven; 1988:557–604.Google Scholar
  39. 39.
    Markham A, Faulds D. Ropivacaine. A review of its pharmacology and therapeutic use in regional anaesthesia. Drugs 1996;52:429–438.PubMedGoogle Scholar
  40. 40.
    Hickey R, Hoffman J, Ramamurthy S. A comparison of ropivacaine 0.5% and bupivacaine 0.5% for brachial plexus block. Anesthesiology 1991;74:639–642.PubMedGoogle Scholar
  41. 41.
    Lee A, Fagan D, Lamont M, et al. Disposition kinetics of ropivacaine in humans. Anesth Analg 1989;69:736–739.PubMedGoogle Scholar
  42. 42.
    Finucane BT. Ropivacaine cardiac toxicity — not as troublesome as bupivacaine. Can J Anaesth 2005;52:449–453.PubMedGoogle Scholar
  43. 43.
    Müller M, Litz RJ, Hubler M, Albrecht DM. PatGrand mal convulsion and plasma concentrations after intravascular injection of ropivacaine for axillary brachial plexus blockade. Br J Anaesth 2001;87:784–787.PubMedGoogle Scholar
  44. 44.
    Kulenkampff D. Brachial plexus anaesthesia: its indications, techniques and dangers. Ann Surg 1928;87:883–888.PubMedGoogle Scholar
  45. 45.
    Bonica JJ. The Management of Pain. 2nd ed. Philadelphia: Lea & Fabinger; 1954.Google Scholar
  46. 46.
    Cheney FW, Domino KB, Caplan RA, et al. Nerve injury associated with anaesthesia: a closed claims analysis. Anesthesiology 1999;90:1062–1069.PubMedGoogle Scholar
  47. 47.
    Selander D, Edshage S, Wolff T. Paresthesia or no paresthesia. Acta Anaesthesiol Scand 1979;23:27–33.PubMedGoogle Scholar
  48. 48.
    Löfström JB, Sjöstrand U. Local Anesthesia and Regional Blockade. Amsterdam: Elsevier; 1988.Google Scholar
  49. 49.
    Moore DC. Regional Block. 4th ed. Springfield, IL: Charles C. Thomas; 1975.Google Scholar
  50. 50.
    Selander D, Dhuner KG, Lundsborg G. Peripheral nerve injury due to injection needles used for regional anaesthesia. Acta Anaesthesiol Scand 1977;21:182–188.PubMedGoogle Scholar
  51. 51.
    Rice ASC, McMahon SB. Peripheral nerve injury caused by injection needles used in regional anesthesia: influence of bevel configuration studied in a rat model. Br J Anaesth 1992;69:433–438.PubMedGoogle Scholar
  52. 52.
    Middleton RW, Varian JP. Tourniquet paralysis. Aust NZ J Surg 1974;44:124–128.Google Scholar
  53. 53.
    Hidou M, Huraux C, Viry-Babel F, et al. Pneumatic tourniquet paralysis: a differential diagnosis after loco-regional anesthesia of the upper limb. J Chir 1992;129:213–214.Google Scholar
  54. 54.
    Fibuch EE, Mertz J, Geller B. Postoperative onset of idiopathic brachial neuritis. Anesthesiology 1996;84:455–457.PubMedGoogle Scholar
  55. 55.
    Selander D, Brattsand R, Lungborg G, et al. Local anesthetics: importance of mode of application, concentration and adrenaline for the appearance of nerve lesions. Acta Anaesthesiol Scand 1979;23:127–136.PubMedGoogle Scholar
  56. 56.
    Selander D. Axillary plexus block, paresthetic or perivascular. Anesthesiology 1987;66:726–728.PubMedGoogle Scholar
  57. 57.
    Vester-Andersen T, Husum B, Lindeburg T, Borrits L, Gothgen I. Perivascular axillary block IV: blockade following 40, 50 or 60ml of mepivacaine 1% with adrenaline. Acta Anaesthesiol Scand 1984;28:99–105.PubMedGoogle Scholar
  58. 58.
    Goldberg ME, Gregg C, Larijani GE, et al. A comparison of three methods of axillary approach to the brachial plexus block for upper extremity surgery. Anesthesiology 1987;66:814–816.PubMedGoogle Scholar
  59. 59.
    Baranowski AP, Pitheer CE. A comparison of three methods of axillary brachial plexus anaesthesia. Anaesthesia 1990;45:362–365.PubMedGoogle Scholar
  60. 60.
    Stan T, Krantz MA, Soloman DL, et al. The incidence of neurovascular complications following axillary brachial plexus block, using a transarterial approach. Reg Anesth 1995;20:486–492.PubMedGoogle Scholar
  61. 61.
    Difazio CA, Carron H, Grosslight KA, et al. Comparison of pH adjusted lidocaine solutions for epidural anesthesia. Anesth Analg 1986;65:760–763.PubMedGoogle Scholar
  62. 62.
    Hilgier M. Alkalinization of bupivacaine for brachial plexus block. Reg Anesth 1985;10:59–61.Google Scholar
  63. 63.
    Morison DH. Alkalinization of local anaesthetics. Can J Anaesth 1995;42:1076–1078.PubMedGoogle Scholar
  64. 64.
    McClure JH, Scott DB. Comparison of bupivacaine HCL and carbonated bupivacaine in brachial plexus block by the interscalene technique. Br J Anaesth 1981;53:523–526.PubMedGoogle Scholar
  65. 65.
    Keeler JF, Simpson JH, Ellis FR. Effect of addition of hyaluronidase to bupivacaine during axillary brachial plexus block. Br J Anaesth 1992;68:68–73.PubMedGoogle Scholar
  66. 66.
    Rosenquist RW, Berman S, Finucane BT. Hyaluronidase and axillary brachial plexus block: effect on latency and plasma levels of local anesthetics [abstract]. Reg Anesth 1989;14:50.Google Scholar
  67. 67.
    Heath PJ, Brownlee GS, Herrick MJ. Latency of brachial plexus block. Anaesthesia 1990;40:297–301.Google Scholar
  68. 68.
    Butterworth JF, Walker FO, Neal JM. Cooling potentiates lidocaine inhibition of median nerve sensory fibers. Anesth Analg 1990;70:507–511.PubMedGoogle Scholar
  69. 69.
    Lavoie J, Marlin R, Tetrault J P. Axillary plexus block using a peripheral nerve stimulator: single or multiple injections. Can J Anaesth 1992;39:583–587.PubMedGoogle Scholar
  70. 70.
    Partridge BL, Katz J, Beninschke K. Functional anatomy of the brachial plexus sheath: implications for anaesthesia. Anesthesiology 1987;66:743–747.PubMedGoogle Scholar
  71. 71.
    Yamamoto K, Tsubokawa T, Shibata K, Kobayashi T. Area of paresthesia as determinant of sensory block in axillary brachial plexus block. Reg Anesth 1995;20:493–497.PubMedGoogle Scholar
  72. 72.
    Urmey WF. Combined axillary-interscalene (axis) brachial plexus block for elbow surgery [abstract]. Reg Anesth 1993;18:88.Google Scholar
  73. 73.
    Bouaziz H, Narchi P, Mercier FJ, et al. Comparison between conventional axillary block and a new approach at mid-humeral level. Anesth Analg 1997;84:1058–1061.PubMedGoogle Scholar
  74. 74.
    Tuohy SA, MacEvilly MA. Inadvertent injection of thiopentone to brachial plexus sheath. Br J Anaesth 1982;54:355–357.PubMedGoogle Scholar
  75. 75.
    Patterson KW, Scanlon P. An unusual complication of brachial plexus sheath cannulation. Br J Anaesth 1990;65:542–543.PubMedGoogle Scholar
  76. 76.
    Winnie AP. Interscalene brachial plexus block. Current researches. Anesth Analg 1970;49:455–466.PubMedGoogle Scholar
  77. 77.
    Brand L, Papper EM. A comparison of supraclavicular and axillary techniques or brachial plexus blocks. Anesthesiology 1961;22:226–229.Google Scholar
  78. 78.
    DeJong RH. Local anesthetics: adverse effects. Springfield, IL: Charles C. Thomas; 1977:254.Google Scholar
  79. 79.
    Ward ME. Interscalene approach to brachial plexus. Anaesthesia 1974;29:147–157.PubMedGoogle Scholar
  80. 80.
    Hickey R, Garland TA, Ramamurthy S. Subclavian perivascular block: influence of location of paresthesia. Anesth Analg 1989;68:767–771. Reg Anesth 1983.PubMedGoogle Scholar
  81. 81.
    Manara AR. Brachial plexus block, unilateral thoraco-abdominal blockade following the supraclavicular approach. Anaesthesia 1987;42:757–759.PubMedGoogle Scholar
  82. 82.
    Brown LD, Cahill DR, Bridenbaugh LD. Supraclavicular nerve block: anatomic analysis of a method to prevent pneumothorax. Anesth Analg 1993;76:530–534.PubMedGoogle Scholar
  83. 83.
    Knoblanche GE. Incidence and etiology of phrenic nerve block in association with supraclavicular brachial plexus block. Anaesth Intensive Care 1979;4:346–349.Google Scholar
  84. 84.
    Farrar MD, Scheybani M, Nolte H. Upper extremity block effectiveness and complications. Reg Anesth 1981;6:133–134.Google Scholar
  85. 85.
    Urmey WF, Talts KH, Sharrock ME. 100% incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia diagnosed by ultra sonography. Anesth Analg 1991;72:498–503.PubMedGoogle Scholar
  86. 86.
    Pere P, Pitkanen M, Rosenberg P. Continuous interscalene brachial plexus block decreases diaphragmatic motility and ventilatory function. Acta Anaesthesiol Scand 1992;36:53–57.PubMedGoogle Scholar
  87. 87.
    Urmey WF, McDonald M. Hemidiaphragmatic paresis during interscalene brachial plexus block: effect on pulmonary function and chest wall mechanics. Anesth Analg 1992;74:352–357.PubMedGoogle Scholar
  88. 88.
    Fujimura N, Anamba H, Tsunoda K, et al. Effect of hemi diaphragmatic paresis caused by interscalene brachial plexus block on breathing, patterns chest wall mechanics and arterial blood gases. Anesthesiology 1995;81:962–966.Google Scholar
  89. 89.
    Kayerker UN, Dick MD. Phrenic nerve paralysis following interscalene brachial plexus block. Anesth Analg 1983;62:536–537.PubMedGoogle Scholar
  90. 90.
    Hood J, Knoblanche G. Respiratory failure following brachial plexus block. Anaesth Intensive Care 1979;7:285–286.PubMedGoogle Scholar
  91. 91.
    Rau RH, Chan YL, Chuang HI. Dyspnea resulting from phrenic nerve paralysis after interscalene block in an obese male. Acta Anaesthesiol Sin 1997;35:113–118.PubMedGoogle Scholar
  92. 92.
    Neal JM, Moore JM, Kopacz DJ, et al. Quantitative assessment of respiratory and sensory function after supraclavicular block. Anesth Analg 1998;86:1239–1244.PubMedGoogle Scholar
  93. 93.
    Al-Kaisy AA, Chan VWS, Perlas A. Respiratory effects of low dose bupivacaine interscalene block. Br J Anaesth 1999;82:217–220.PubMedGoogle Scholar
  94. 94.
    Betts A, Eggan JR. Unilateral pulmonary edema with interscalene block. Anesthesiology 1998;88:1113–1114.PubMedGoogle Scholar
  95. 95.
    Candido KD, Sukhani R, Doty R, et al. Neurologic sequelae after interscalene brachial plexus block for shoulder/upper arm surgery: the association of patient, anesthetic, and surgical factors to the incidence and the clinical course. Anesth Analg 2005;100:1489–1495.PubMedGoogle Scholar
  96. 96.
    Barutell C, Videll F, Raich M, et al. Neurological complication following interscalene brachial plexus block. Anaesthesia 1980;35:365–367.PubMedGoogle Scholar
  97. 97.
    Lim EK, Pereira R. Brachial plexus injury following brachial plexus block. Anaesthesia 1984;39:691–695.PubMedGoogle Scholar
  98. 98.
    Bashein G, Thompson-Robertson H, Kennedy WF Jr. Persistent phrenic nerve paresis following interscalene brachial plexus block. Anesthesiology 1985;63:102–104.PubMedGoogle Scholar
  99. 99.
    Robaux S, Bouaziz H, Boisseau N, et al. Persistent phrenic nerve paralysis following interscalene brachial plexus block. Anesthesiology 2001;95:1519–1521.Google Scholar
  100. 100.
    Passannante PAN. Spinal anaesthesia and permanent neurologic deficit after interscalene block. Anesth Analg 1996;82:873–874.PubMedGoogle Scholar
  101. 101.
    Brockway MS, Winter AW, Wildsmith JA. Prolonged brachial plexus block with 0.42% bupivacaine. Br J Anaesth 1989;63:604–605.PubMedGoogle Scholar
  102. 102.
    Shantha TR, Evans JA. The relationship of epidural anesthesia to neural membranes and arachnoid villi. Anesthesiology 1972;37:543–557. Review. No abstract available.PubMedGoogle Scholar
  103. 103.
    Kumar A, Battit GE, Froese AB, et al. Bilateral cervical and thoracic epidural blockade complicating interscalene brachial plexus block — 2 cases. Anesthesiology 1971;35:650–652.PubMedGoogle Scholar
  104. 104.
    Ross S, Scarborough CD. Total spinal anesthesia following brachial plexus block. Anesthesiology 1974;39:458.Google Scholar
  105. 105.
    Edde S, Deutsch S. Cardiac arrest after interscalene brachial plexus block. Anesth Analg 1977;56:446–447.PubMedGoogle Scholar
  106. 106.
    McGlade DP. Extensive central neural blockade following interscalene brachial plexus block. Anaesth Intensive Care 1992;20:514–516.PubMedGoogle Scholar
  107. 107.
    Baraka A, Hanna M, Hammoud R. Unconsciousness and apnea complicating parascalene brachial plexus block, possible subarachnoid block. Anesthesiology 1992;77:1046–1047.PubMedGoogle Scholar
  108. 108.
    Dutton RP, Eckhardt WF III, Sunder N. Total spinal anesthesia after interscalene blockade of the brachial plexus. Anesthesiology 1994;80:939–941.Google Scholar
  109. 109.
    Norris D, Klahsen A, Milne B. Delayed bilateral spinal anesthesia, following interscalene block. Can J Anaesth 1996;43:303–305.PubMedGoogle Scholar
  110. 110.
    Majid A, van den Oever HL, Walstra GJ, Dzoljic M. Spinal anesthesia as a complication of brachial plexus block using the posterior approach. Anesth Analg 2002;94:1338–1339.Google Scholar
  111. 111.
    Al-Khafaji JM, Ellias MA. Incidence of Horner’s syndrome with interscalene brachial plexus block and its importance in the management of head injury. Anesthesiology 1986;64:127.PubMedGoogle Scholar
  112. 112.
    Sukhani CR, Barclay LJ, Aasen M. Prolonged Horner’s syndrome after interscalene block: a management dilemma. Anesth Analg 1994;79:701–745.Google Scholar
  113. 113.
    Rollins M, McKay WR, Eshima RE. Airway difficulty after subclavian perivascular block. Anesth Analg 2003;96:1191–1192.Google Scholar
  114. 114.
    Plit ML, Chhajed PN, MacDonald P, et al. Bilateral vocal cord palsy following Interscalene brachial plexus block. Anaesth Intensive Care 2002;30:499–501.Google Scholar
  115. 115.
    Thiagarajah S, Moore E, Azar I, et al. Bronchospasm following interscalene brachial plexus block. Anesthesiology 1984;61:759–761.PubMedGoogle Scholar
  116. 116.
    Shah MB, Hirschman DA. Sympathetic blockade cannot explain bronchospasm following interscalene brachial plexus block. Anesthesiology 1985;62:847.PubMedGoogle Scholar
  117. 117.
    Durrani Z, Winnie AP. Brainstem toxicity with reversible “locked in syndrome” after interscalene brachial plexus block. Anesth Analg 1991;72:249–252.PubMedGoogle Scholar
  118. 118.
    Mani M, Ramamurthy N, Rao TLK, et al. An unusual complication of brachial plexus block and heparin therapy. Anesthesiology 1978;48:213–214.PubMedGoogle Scholar
  119. 119.
    Siler PL, Lief JS, Davis JS. A complication of interscalene brachial plexus block. Anesthesiology 1973;38:590–591.PubMedGoogle Scholar
  120. 120.
    Rosenberg PH, Lambert TS, Tarkkila T, et al. Auditory disturbance associated with interscalene brachial plexus block. Br J Anaesth 1995;74:89–91.PubMedGoogle Scholar
  121. 121.
    Schroeder LE, Horlocker TT, Schroeder DR. The efficacy of axillary block for surgical procedures about the elbow. Anesth Analg 1996;83:747–751.PubMedGoogle Scholar
  122. 122.
    Merrill DJ, Brodsky JB, Hentz RH. Vascular insufficiency following axillary block of the brachial plexus. Anesth Analg 1981;60:162–164.PubMedGoogle Scholar
  123. 123.
    Resteiii L, Pingiroli D, Conoscente F, et al. Insufficient venous drainage following axillary approach to brachial plexus blockade. Br J Anaesth 1984;56:1051–1053.Google Scholar
  124. 124.
    Ott L, Neuberger L, Frey HP. Obliteration of the axillary artery after axillary block. Anaesthesia 1989;44:773–774.PubMedGoogle Scholar
  125. 125.
    Dudrick S, Masland W, Mishkin M. Brachial plexus injury following axillary artery puncture. Radiology 1967;88:271–273.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Brendan T. Finucane
    • 1
  • Ban C. H. Tsui
    • 1
    • 2
  1. 1.Department of Anesthesiology and Pain MedicineUniversity of AlbertaEdmontonCanada
  2. 2.University of Alberta Hospital and Stollery Children’s HospitalEdmontonCanada

Personalised recommendations