Ultrasound-Guided Axillary Brachial Plexus Block, Performed by Orthopedic Surgeons

Cheol-U Kim; Chul-Hyung Lee; Ja-Yeong Yoon; Seung-Koo Rhee

doi:10.4055/jkoa.2018.53.6.513

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Kim, Lee, Yoon, and Rhee: Ultrasound-Guided Axillary Brachial Plexus Block, Performed by Orthopedic Surgeons

Original Article

J Korean Orthop Assoc 2018;53(6):513-521.

Published online: 1 December 2018

DOI: https://doi.org/10.4055/jkoa.2018.53.6.513

Ultrasound-Guided Axillary Brachial Plexus Block, Performed by Orthopedic Surgeons

Cheol-U Kim, M.D., Chul-Hyung Lee, M.D., Ph.D., Ja-Yeong Yoon, M.D., Seung-Koo Rhee, M.D., Ph.D.

Department of Orthopedic Surgery, Daejeon Sun Hospital, Daejeon, Korea

Correspondence to: Chul-Hyung Lee, M.D., Ph.D. Department of Orthopedic Surgery, Daejeon Sun Hospital, 29 Mokjung-ro, Jung-gu, Daejeon 34811, Korea TEL: +82-42-220-8460 FAX: +82-42-220-8464 E-mail: mediiron@naver.com ORCID: https://orcid.org/0000-0003-4059-4969

Received 23 October 2017 Revised 14 December 2017 Accepted 12 February 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to assess the effectiveness and complications of an ultrasound-guided axillary brachial plexus block performed by orthopedic surgeons.

Materials and Methods

From March to May 2017, an ultrasound-guided axillary brachial plexus block was performed on a total of 103 cases of surgery. A VF13-5 transducer from Siemens Acuson X300 was used. The surgical site was included in the range of the anatomic sensory distribution of the blocked nerve, except for the case where an operation time of more than 2 hours was expected due to multiple injuries and the operation of the upper arm. The procedure was performed by 2 orthopedic surgeons in the same method using 50 ml of solution (20 ml of lidocaine HCl in 2%, 20 ml of ropivacaine in 0.75%, 10 ml of normal saline in 0.9%). The success rate of anesthesia induction during surgery, anesthetic induction time, anatomical range of operation, duration of postoperative analgesia and complications were investigated.

Results

The results from the 2 practices were similar. The anesthesia was successful in 100 out of 103 patients (97.1%). In these patients, the average needling time was 5.5 minutes (2.5–13.2 minutes), the average induction time to complete anesthesia was 18.4 minutes (5–40 minutes), and the average duration of postoperative analgesia was 402.8 minutes (141–540 minutes). The post-anesthesia immediate complications were dizziness in 1 case, nausea and vomiting in 4 cases, and peri-oral numbness in 2 cases, but surgery was performed without problems. All these 7 cases with complications recovered on the same day. A total of 3 cases failed with anesthesia, and they were treated by an injection with local anesthesia in the operation room in 2 cases and switched to general anesthesia in 1 case.

Conclusion

An ultrasound-guided axillary brachial plexus block, which was performed by orthopedic surgeons allows anesthesia in a brief period and the high success rates of anesthesia for certain surgeries of the elbow and surgeries on forearm, wrist and hand. Therefore, it can reduce the waiting time to the operating room. This technique is a relatively safe procedure and dose selective anesthesia is possible.

Keywords: ultrasound-guided, axillary brachial plexus block, orthopedic surgeons

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Figure 1

(A, C, D) Patient position and the location of the probe for performing axillary brachial plexus block. (B) Anesthetic preparation composed of lidocaine HCl 2% 20 ml, ropivacaine 0.75% 20 ml, 0.9% normal saline 10 ml, 50 ml syringe, 23-guage spinal needle and intravenous extension line. (E) In-plane needling for axillary brachial plexus block.

Figure 2

(A) Ultrasound anatomy of axilla. (B) In-plane needle approching (arrows). AA, axillary artery; M, median nerve; U, ulnar nerve; R, radial nerve; MC, musculocutaneous nerve; CBM, coracobrachialis muscle.

Figure 3

(A–D) Left pictures: before injection; Right pictures: after injection, each nerves are surrounded by hypoechoic local anesthetics on right pictures each. (A) Musculocutaneous nerve block. On left picture: the needle tip is located between the MCN and the fascia of CBM (arrow). (B) Radial nerve block. (C) Median nerve (arrow) block. (D) Ulnar nerve (arrow) block. AA, axillary artery; CBM, coracobrachialis muscle; MCN, musculocutaneous nerve; R, radial nerve; M, median nerve; U, ulnar nerve. Arrowheads in all pictures are indicate needle.

Table 1

Baseline Demographics and Surgical Sites (Period, March 2017 to May 2017)

Variable	Value
No. of patient	103
Sex (male/female)	56/47
Age (yr)	49.6 (15–84)
Surgical site
Elbow	11
Forearm	4
Wrist	45
Hand	43

Values are presented as number only or median (range).

Table 2

Preoperative Diagnosis and Surgical Site of Cases

	Elbow	Forearm	Wrist	Hand	Total
Fracture	Head of radius 2	-	Distal radius 21	Metacarpus 9	45
				Phalange 13
United fracture	Olecranon process 2	Ulnar shaft 3	Distal radius 10	-	15
Nerve entrapment	Cubital tunnel syndrome 6	-	Carpal tunnel syndrome 5		11
Tendon rupture	-	-	-	5	5
Trigger finger	-	-	-	3	3
Etc.	1	1	2	8	12
Mass	-	-	7	5	12
Total	11	4	45	43	103

Values are presented as number only.

Table 3

Results of Ultrasound-Guided Axillary Brachial Plexus Block

Variable	Value
Successful surgical anesthesia without supplementation	100/103 (97.1)
Needling time (min)	5.5 (2.5–13.2)
Time to complete block (min)	18.4 (5–40)
Time of analgesia (min)	402.8 (141–540)
Complications	7/103 (6.7)
Dizziness	1
Nausea & vomiting	4
Peri-oral numbness	2
Supplementation
Local anesthesia	2
General anesthesia	1

Values are presented as number/total number (%), median (range), or number only.

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