Abstract
The axillary brachial plexus block has a long history as a popular technique for providing regional anesthesia at and below the elbow. The surface landmarks (chiefly the axillary artery pulsation) are easily ascertained, and there is no risk of pneumothorax. A variety of landmark-guided approaches have been described, including elicitation of paresthesia, transarterial injection, and single- and multiple-injection neurostimulation techniques. The main issues with the landmark-guided approaches were variable efficacy and the risk of intravascular injection of local anesthetic. The advent of ultrasound guidance has effectively addressed these concerns. It is at least as effective as the supraclavicular and infraclavicular blocks, if not more so because of the ability to individually target the four main terminal nerves of the arm. The shallow depth of the brachial plexus in this location allows excellent visualization of both nerves and needle. Inadvertent intraneural and intravascular injections remain the only significant risks, but both are easily avoided with ultrasonographic visualization.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Tran DQH, Russo G, Muñoz L, Zaouter C, Finlayson RJ. A prospective, randomized comparison between ultrasound-guided supraclavicular, infraclavicular, and axillary brachial plexus blocks. Reg Anesth Pain Med. 2009;34:366–71.
Chin KJ, Alakkad H, Cubillos JE. Single, double or multiple-injection techniques for non-ultrasound guided axillary brachial plexus block in adults undergoing surgery of the lower arm. Cochrane Database Syst Rev. 2013;(8):CD003842.
Berthier F, Lepage D, Henry Y, Vuillier F, Christophe J-L, Boillot A, Samain E, Tatu L. Anatomical basis for ultrasound-guided regional anaesthesia at the junction of the axilla and the upper arm. Surg Radiol Anat: SRA. 2010;32:299–304.
Selander D, Edshage S, Wolff T. Paresthesiae or no paresthesiae? Nerve lesions after axillary blocks. Acta Anaesthesiol Scand. 1979;23:27–33.
Baranowski AP, Pither CE. A comparison of three methods of axillary brachial plexus anaesthesia. Anaesthesia. 1990;45:362–5.
Stan TC, Krantz MA, Solomon DL, Poulos JG, Chaouki K. The incidence of neurovascular complications following axillary brachial plexus block using a transarterial approach. A prospective study of 1,000 consecutive patients. Reg Anesth. 1995;20:486–92.
Bloc S, Mercadal L, Dessieux T, Garnier T, Estebe J-P, Le Naoures A, Komly B, Leclerc P, Morel B, Ecoffey C, Dhonneur G. The learning process of the hydrolocalization technique performed during ultrasound-guided regional anesthesia. Acta Anaesthesiol Scand. 2010;54:421–5.
Bernucci F, Gonzalez AP, Finlayson RJ, Tran DQH. A prospective, randomized comparison between perivascular and perineural ultrasound-guided axillary brachial plexus block. Reg Anesth Pain Med. 2012;37:473–7.
Cho S, Kim YJ, Kim J-H, Baik H-J. Double-injection perivascular ultrasound-guided axillary brachial plexus block according to needle positioning: 12 versus 6 o’clock position of the axillary artery. Korean J Anesthesiol. 2014;66:112–9.
Choyce A, Chan VW, Middleton WJ, Knight PR, Peng P, McCartney CJ. What is the relationship between paresthesia and nerve stimulation for axillary brachial plexus block? Reg Anesth Pain Med. 2001;26:100–4.
Perlas A, Niazi A, McCartney C, Chan V, Xu D, Abbas S. The sensitivity of motor response to nerve stimulation and paresthesia for nerve localization as evaluated by ultrasound. Reg Anesth Pain Med. 2006;31:445–50.
Casati A, Danelli G, Baciarello M, Corradi M, Leone S, Di Cianni S, Fanelli G. A prospective, randomized comparison between ultrasound and nerve stimulation guidance for multiple injection axillary brachial plexus block. Anesthesiology. 2007;106:992–6.
Lanz E, Theiss D, Jankovic D. The extent of blockade following various techniques of brachial plexus block. Anesth Analg. 1983;62:55–8.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Chin, K.J. (2015). Axillary Brachial Plexus Block. In: Regional Nerve Blocks in Anesthesia and Pain Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-05131-4_32
Download citation
DOI: https://doi.org/10.1007/978-3-319-05131-4_32
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-05130-7
Online ISBN: 978-3-319-05131-4
eBook Packages: MedicineMedicine (R0)