A new axillary approach for continuous brachial XXXX . A clinical and anatomic study.

@entity1 @entity845 @entity1341 @entity86 @entity158 @entity531 @entity616
Catheter insertion in the neurovascular space by axillary approach allows a continuous brachial @entity86 . We developed a perivenous technique whereby the approach to the @entity531 is guided under fluoroscopy by a preopacified axillary vein. A randomized study compared this technique to the technique of Selander in ASA grade I-II @entity1 scheduled for surgery or painful physiotherapy of the hand. The study was performed in 36 @entity1 randomly divided into two groups. In Group 1 (n = 18), the catheter was placed according to the technique described by Selander. In Group 2 (n = 18), the catheter was placed using our perivenous technique. A complete block was obtained in all the @entity1 of Group 2 vs only 50% of the @entity1 in Group 1 (P < 0.05). In Group 1 a partial block was observed in 17%, with failure in 33% of the @entity1 . There was no difference in the two groups regarding the time required to perform either technique, the duration of the complete block, the @entity158 score, or the amount of continuously administrated @entity1341 during the first 48 h postoperatively. The plasma concentrations of total @entity1341 (high-performance liquid chromatography) were low in successful blocks, with no differences in the two groups; the median value was 0.68 microgram/mL (95% confidence interval: 0.62-0.89). The concentrations were higher (P < 0.01) in failed blocks; the median value was 1.69 micrograms/mL (95% confidence interval: 0.58-2.8). A complementary anatomic study of three arms from fresh cadavers allowed verification of the correct localization of the Teflon cannula and flexible catheter, as well as homogeneous diffusion of the @entity845 blue inside the brachial plexus. The perivenous technique for continuous axillary brachial @entity616 may improve the success rate due to its radiologic and accurate location of the @entity531 .
