Abstract ID: A40
Abstract Title: Brachial plexus anesthesia with a perivascular axillar approach: Influence of lateral position onto the anesthetized side combined with 20° Trendelenburg Positioning
Poster Type: Poster
ABSTRACT BODY
Introduction:
The axillary block with perivascular axillar approach (AB) is indicated for hand and arm surgery. None of the axillary techniques yet published has shown a sufficient block of the axillary nerve (AN), thoracodorsalis nerve (TN) and the subscapulary nerve (SN), presumably, because these nerves exits the plexus earlier. Therefore, we prospectively studied 72 patients (ASA I–III) to investigate an influence of positioning the patient on the extension of anaesthesia during AB.
Materials and Methods:
The local ethics committee waived the need for informed consent, since the AB is a standard anesthesia technique. Patients were randomized into two groups: group A (axillary approach; n=36) and group AMP (axillary approach with modified position, n=36). The modified position, a lateral positioning onto the anesthetized side combined with 20° Trendelenburg positioning about 30 minutes, was performed after the AB in single injection technique (50 ml mepivacaine 1%) was conducted. Additionally, the musculocutaneous nerve (MN) was blocked with 10ml mepivacaine 1%, because block of the MN is often incomplete. Quality of sensory and motor block was recorded selectively for AN and motor blockade for TN, and SN at time point 0 and after 30 min.
Results:
In group A (n=36), the AN, TN, and the SN remained unblocked. In group AMP (n=36), a complete sensory blockade of the AN in 21 patients (58%), and an incomplete in 12 (33%), was observed. A motor blockade of the AN in 31 (86%) occurred. A motor blockade of the TN and SN was remarkable in 27 patients (75%).
Discussion:
These results demonstrate clearly the influence of different positioning on the extension of brachial plexus anesthesia. Using the AB and a lateral position onto the anesthetized side, combined with 20° Trendelenburg positioning, a remarkable AN, TN, and SN block is achievable.
ATTACHED FILES
Reg Anesth Pain Med 2004; 29(2):A40