Three Techniques for Ultrasound Guided Axillary Brachial Plexus Block

Prospective Randomized Study of Three Different Techniques for Ultrasound Guided Axillary Brachial Plexus Block

The brachial plexus block is an anesthetic technique often used for surgical procedures of the upper limb. The brachial plexus block through the axilla (BPVA) is one of the techniques most commonly used to obtain regional anesthesia of the upper limbs, being performed by anesthesia of the terminal branches of the brachial plexus, which would be the ulnar, median, radial and musculocutaneous nerves. With the aid of ultrasound , two techniques can be used to perform the BPVA . The first , known as multiple puncture technique , the local anesthetic is deposited around each nerve that want to block . This technique is most commonly used to perform the BPVA . The second technique , known as 2 injections , local anesthetic is deposited below the axillary artery and around the musculocutaneous nerve . This technique has been proposed to try to reduce the execution time of anesthesia . Studies actually show that the technique of 2 injections showed less time to perform the block, with the same success rate. However, the technique of 2 injections showed a longer latency and higher rate of vascular puncture . (14) In order to perform a procedure with shorter execution time , without changing the latency, success rate and ensuring patient safety , the investigators designed this protocol to evaluate three techniques for performing the ultrasound- guided axillary brachial plexus block.

Inclusion Criteria:

• Informed consent signed by the patient (IC)
• Indication for brachial plexus block for anesthesia and analgesia in candidates for hand surgical procedures
• ASA physical status I, II or III according to the American Association of Anesthesiology.

Exclusion Criteria:

• Cognitive impairment or psychiatric disease
• Active infection condition at the puncture site of the block
• Bleeding disorders
• History of allergy to bupivacaine.