AXILLARY BRACHIAL-PLEXUS BLOCK IN 200 CONSECUTIVE PATIENTS

Two hundred consecutive, minimally-sedated patients presenting for upp er limb surgery were audited prospectively to determine the overall cl inical success rate, extent of cutaneous neural blockade, reliability and complication rate of each indicator of axillary sheath entry, and degree of patient satisfaction. The axillary sheath was identified, us ing a 22 gauge, short-bevelled needle, by one of four indicators, whic hever was elicited first (paraesthesia, arterial or venous puncture, o r tethering by the axillary sheath). Alkalinized mepivacaine 1.2%, 50 mi then was injected. The cutaneous distribution of the block was mapp ed in the presence of minimal sedation. Anaesthesia was supplemented w ith peripheral nerve blocks where necessary. Patients were followed up with a mailed questionnaire and surgeon interview. The overall clinic al success rate was 92.5%, improving to 99% with supplementary nerve b locks. Complete anaesthesia distal to the elbow was achieved in 85% of patients. Complications were common, but generally mild and transient : mild acute local anaesthetic toxicity, 3.5%; axillary tenderness and bruising, 12%; and dysaesthesias, 12.5%. Despite this, patient satisf action was high (97%).