A Comparison of Proximal and Distal Radial Nerve Motor Responses in Axillary Block Using Triple Stimulation

A Comparison of Injection at the Ulnar and the Radial Nerve in Axillary Block Using Triple Stimulation

“…[1][2][3][4][5][6][7] This approach, a simplification of the 4injection technique first published by Koscielniak-Nielsen et al 8,9 in the late 1990s, was proposed in 2001. 1,2 It consists of the localization of 2 nerves, the median and the musculocutaneous, which lie superior (laterally) to the axillary artery, and of 1 nerve, the radial, which lies inferior (medially) to the artery.…”

Sonographic Location of the Radial Nerve Confirmed by Nerve Stimulation During Axillary Brachial Plexus Blockade

“…Elbow extension (triceps muscle contraction) has been considered an acceptable nerve stimulator response for identification and blockade of the radial nerve during ABP block, 3 although finger or wrist extension has been shown to be a more reliable indicator 8 and not prone to confusion with direct muscle stimulation (triceps) or stimulation of the nerve to triceps. In our study, the best nerve stimulator response was often accepted as elbow extension, despite attempts in all cases to obtain finger or wrist extension.…”

“…The type of motor response was also recorded. Finger or wrist extension was considered superior to elbow extension 8 and sought in all patients. If the needle tip was adjacent to a nerve structure with elbow extension as the response, then it was redirected to a different part of the nerve, with the aim of producing finger or wrist extension.…”

Recognition of local anesthetic maldistribution in axillary brachial plexus block guided by ultrasound and nerve stimulation

“…Perlas et al found that peripheral nerve stimulation was 74.5% sensitive in eliciting motor stimulation despite clear needle-to-nerve contact [4]. Further, peripheral nerve stimulation-guided axillary blockade may not effectively cover all anticipated sensory distributions associated with an appropriate motor twitch response [5]. In axillary blocks, fascial septations of the brachial plexus sheath have been proposed to interfere with spread of local anesthetic injectate, causing partial or ineffective blocks [6].…”