AXILLARY BRACHIAL-PLEXUS BLOCK - AN UNDERUSED TECHNIQUE IN THE ACCIDENT AND EMERGENCY DEPARTMENT

Objective-To compare axillary brachial plexus block and Pier's block a s methods of providing upper limb anaesthesia. Methods-Axillary brachi al plexus or Pier's blocks were performed on all patients requiring up per limb anaesthesia in a three month period. For Bier's block, a sing le cuff tourniquet and 3 mg/kg 0.5% prilocaine were used. For axillary plexus block, 40 ml 1% lignocaine with adrenaline (1:200 000) were us ed, given by perivascular or transarterial technique. Prospective anal ysis was made of time to complete limb anaesthesia, type of procedure performed, and duration of limb anaesthesia. Patient perception of ana lgesia and satisfaction with the method of anaesthesia was assessed us ing a 10 point visual analogue scale. Results-75 patients underwent pr ocedures requiring upper limb anaesthesia; 39 received axillary plexus block and 36 Pier's block. 72% of Bier's blacks and 77% of axillary p lexus blocks provided complete anaesthesia without the need for supple mental analgesia. The median time to onset of anaesthesia was 10 min f or Pier's block and 32.5 min for axillary block (P < 0.001). The media n duration of anaesthesia was 15 min for Bier's block and 240 min for axillary block (P < 0.001). Mean scores for analgesia were 9.7 for axi llary blocks and 8.8 for Bier's block (P < 0.001). 87% of the axillary block group were completely satisfied with the method of anaesthesia, compared with 56% of the Bier's block group. Conclusions-Brachial ple xus blocks are an alternative form of providing upper limb anaesthesia in the accident and emergency department. They are relatively simple to perform, well tolerated by patients, and have the advantage of prov iding prolonged analgesia without the need for additional medication.