Selective Ulnar Nerve Localization Is Not Essential for Axillary Brachial Plexus Block Using a Multiple Nerve Stimulation Technique

Patients' experiences with multiple stimulation axillary block for fast‐track ambulatory hand surgery

“…Several recent reports assessed global pain caused by multiple electrolocation and injection techniques for peripheral nerve blocks (1–7). None of the studies identified the main cause of pain/discomfort, although one report (7) and a review article (8) suggested that withdrawal/redirection of the needle is the major culprit.…”

“…Based on previous studies on axillary block (1–4) we estimated that 100 patients would be sufficient to obtain clinically relevant information within the available time period. This number would also be easy to present and handle statistically.…”

“…M ultiple injection techniques provide an effective axillary block of rapid onset (1–4), which together with avoidance of recovery room can facilitate fast‐tracking in ambulatory hand surgery. However, fear of the block itself may decrease patients' acceptance of regional anesthesia.…”

“…However, fear of the block itself may decrease patients' acceptance of regional anesthesia. Several recent studies assessed block pain (1–7) and found that it is reduced both by sedation/analgesia and by fewer injections (3,4). Nevertheless, it is still unknown which part of the block causes most intense pain and whether detailed explanation and own experience of the blocking procedure reduces patients' anxiety about future blocks.…”

A comparison of the vertical infraclavicular and axillary approaches for brachial plexus anaesthesia

“…Blockade of the musculocutaneous nerve is a steady exception in axillary approach, as this nerve leaves the neurovascular compartment already at the level of the coracoid process. Sia et al (12) and Coventry et al (13), comparing multiple injection techniques in the axillary approach, independently reported that a separate block of the musculocutaneous nerve is necessary for complete sensory analgesia of the limb and to prevent tourniquet discomfort. Yamamoto et al (14), using a single injection technique, found that when paraesthesia was induced in the area supplied by the median nerve, the musculocutaneous nerve was also blocked in 72% of the patients.…”