P. Inberg et al., Double-injection method using peripheral nerve stimulator is superior to single injection in axillary plexus block, REG ANES PA, 24(6), 1999, pp. 509-513
Background and Objectives. Axillary block using a single-injection method d
oes not always provide effective analgesia. This study examined whether a d
ouble axillary block injection technique is superior to a single injection
axillary block. Methods. Fifty patients were randomly allocated to two grou
ps. In group 1 (single injection), the whole volume of local anesthetic (0.
7 mL/kg) was injected after locating only one of the median, radial, or uln
ar nerves. In group 2 (double injection), half of the volume was injected a
fter locating one nerve and the other half after locating another periphera
l nerve. Bupivacaine 0.5% and prilocaine 1% (1:1 volumes) were used as loca
l anesthestic. A peripheral nerve stimulator was used to identify the nerve
s. Sensory block of seven nerves and motor block of four nerves were tested
after 40 minutes. Results. Complete sensory and motor block (scores 2 or 3
on scale 0-3) in all four main nerves (median, ulnar, radial, musculocutan
ceous) was achieved in 3 (12%) versus 20 (80%) patients in groups 1 and 2,
respectively (P = .000001). Primary success rate (no need for supplemental
nerve block) was 52% in group 1 and 92% in group 2 (P = .0016). Conclusions
. A double-injection method in axillary block provides excellent analgesia
and motor block compared with a single-injection method. Moreover, the need
for supplemental nerve blocks is significantly decreased.