Ultrasound-guided axillary approach for brachial plexus block reduces block onset time compared to midhumeral approach

Abstract

Aim: Brachial plexus block under ultrasonography guidance is a successful and frequently used anesthesia method for hand, wrist and forearm surgery. Brachial plexus block can be performed with axillary or midhumeral approach technique. In this study, we aimed to compare the intraoperative and postoperative anesthetic and analgesic properties of axillary or midhumeral approach in ultrasonography-guided brachial plexus block.Material and Methods: This randomized, controlled, double-blind, single-center study included 90 ASA I-III risk patients, aged 18-70 years, who underwent hand, wrist and forearm surgery. In Group I, axillary; in Group II, midhumeral approach techniques were performed for brachial plexus block. Cold test was used to evaluate sensory block, and three-point scale was used to evaluate motor block. Postoperative pain was assessed by visual analog scale.Results: There was no statistical difference between age, height, weight, BMI and gender characteristics of the patients included in the study. There was no statistically significant difference between the groups in terms of block onset and regression times on both sensory and motor examination (p> 0.05). The main result was that axillary approach shortens the complete block onset time on both sensory and motor examination (p <0.05). Another important result was that axillary approach provides higher surgeon and patient satisfaction levels significantly comparing to mid-humeral approach (p <0.05). Conclusion: Both approaches can be applied successfully in brachial plexus block and can be used effectively in elective surgeries. In patients who underwent axillary approach technique for brachial plexus block, full block onset time is earlier than in patients undergoing midhumeral approach technique. Therefore, axillary approach technique may be preferred in cases requiring urgent surgical intervention.