Comparison of transarterial and multiple nerve stimulation techniques for an initial axillary block by 45 mL of XXXX 1% with adrenaline.

@entity1 @entity1425 @entity10541 @entity1337 @entity616
BACKGROUND: The single-injection axillary block is rapidly performed but gives unpredictable results. @entity616 by multiple nerve stimulation technique (MNS) gives better results, but takes longer to perform. Transarterial (TA) injections of high doses of local anaesthetics are very successful. This double-blind study compared both block effectiveness and anaesthesiologic time consumption in 100 @entity1 , having an axillary block by either TA or MNS techniques. METHODS: 45 mL of 1% @entity10541 with @entity1425 5 microg/mL was used in each @entity1 . Five mL was injected subcutaneously. In the TA group, 20 mL was injected deep to, and 20 mL superficial to the axillary artery. In the MNS group, four terminal motor nerves were electrolocated in the axilla, and injected with 10 mL each. @entity1337 was assessed every 10 min and when needed supplemented after 30 min. The block was considered successful when analgesia was present in all sensory nerve areas distal to the elbow. RESULTS: MNS group required 10+/-2 min (mean+/-1 SD) for the @entity616 performance compared with 7+/-2 min for TA group, P<0.001. Latency of the @entity616 was shorter and the frequency of supplemental analgesia lower in the MNS group (mean 17 min and 12%), than in the TA group (25 min and 38%, respectively), P<0.001. All incomplete @entity616 were successfully supplemented by electrolocating the unblocked nerves. However, the total time to obtain 100% success rate was shorter in the MNS group (30 min), than in the TA group (38 min), P<0.001. The adverse effects (accidental intravascular injections and axillary haematomas) were fewer in the MNS group. CONCLUSION: In the hands of anaesthetists experienced in nerve electrolocation, the MNS technique of an initial axillary block by four separate injections of 10 mL of @entity10541 produces faster and more extensive block than the TA technique by two separate injections of 20 mL. Hence, the MNS technique requires fewer @entity616 and results in faster @entity1 readiness for surgery than the TA technique.
