Randomized prospective study of three different techniques for ultrasound-guided axillary brachial plexus block

Abstract

IntroductionRandomized prospective study comparing two perivascular techniques with the perineural technique for ultrasound-guided axillary brachial plexus block (US-ABPB). The primary objective was to verify if these perivascular techniques are noninferior to the perineural technique. Method240 patients were randomized to receive the techniques: below the artery (BA), around the artery (AA) or perineural (PN). The anesthetic volume used was 40mL of 0.375% bupivacaine. All patients received a musculocutaneous nerve blockade with 10mL. In BA technique, 30mL were injected below the axillary artery. In AA technique, 7.5mL were injected at 4 points around the artery. In PN technique, the median, ulnar, and radial nerves were anesthetized with 10mL per nerve. ResultsConfidence interval analysis showed that the perivascular techniques studied were not inferior to the perineural technique. The time to perform the blockade was shorter for the BA technique (300.4±78.4s, 396.5±117.1s, 487.6±172.6s, respectively). The PN technique showed a lower latency time (PN – 655.3±348.9s; BA – 1044±389.5s; AA – 932.9±314.5s), and less total time for the procedure (PN – 1132±395.8s; BA – 1346.2±413.4s; AA – 1329.5±344.4s). BA technique had a higher incidence of vascular puncture (BA – 22.5%; AA – 16.3%; PN – 5%). ConclusionThe perivascular techniques are viable alternatives to perineural technique for US-ABPB. There is a higher incidence of vascular puncture associated with the BA technique.