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

Wong, Daniel M.; Gledhill, Samuel; Thomas, Rod; Barrington, Michael J.

doi:10.1097/aap.0b013e3181ae7323

Cited by 13 publications

(6 citation statements)

References 13 publications

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“…The higher volume required to surround the radial nerve probably reflects the relative difficulty of identifying this nerve in the axilla and ensuring that it was surrounded with anaesthetic. It may have been helpful to use nerve stimulation when performing the blocks for this reason, as suggested for the radial nerve by Wong and colleagues 14 recently. In contrast, the musculocutaneous nerve tended to be surrounded with a relatively low volume, probably explained by its location between the two fascial planes of biceps and coracobrachialis.…”

Section: Discussionmentioning

confidence: 99%

Minimum volume of local anaesthetic required to surround each of the constituent nerves of the axillary brachial plexus, using ultrasound guidance: a pilot study

Harper

Stafford

Hill

2010

British Journal of Anaesthesia

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Section: Discussionmentioning

confidence: 99%

Minimum volume of local anaesthetic required to surround each of the constituent nerves of the axillary brachial plexus, using ultrasound guidance: a pilot study

Harper

Stafford

Hill

2010

British Journal of Anaesthesia

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“…The ultrasound anatomy and the disposition of nerves in the axillary fossa have been investigated both clinically and anatomically to elucidate the nerve–vessel relationship. Gili et al () described the pattern of distribution of nerves around the brachial artery as assessed by ultrasound scanning and neurostimulation during the plexus blockade: the position of the radial nerve is at four or five o'clock in most cases, though there are variations, and the radial nerve is more difficult to visualize than other nerves (Wong et al, ; Silva et al, ). The recognition and disposition of the radial nerve are matters of interest for the clinician, who has to decide whether to direct the needle just above or below the artery to reach it.…”

Section: Introductionmentioning

confidence: 99%

“Triceps Brachii Muscle Response to Neurostimulation of the Radial Nerve during Axillary Plexus Blockade: Clinical, Anatomical and Histological Correlation”

et al. 2019

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Axillary plexus blockade is a common technique in clinical practice with a well-known pattern of structures around the brachial artery. Historically, the only proper response to radial nerve stimulation was considered to be extension of the hand and wrist. Twenty-five axillary blockades were assessed by ultrasound and neurostimulation; the principal objective was to correlate the needle position over the radial nerve with the anatomical and histological structure of that nerve. During the procedure, the needle was directed in two ways to reach the medial or lateral margin of the nerve: above the brachial artery or beneath it. Once the needle reached the nerve, the current was augmented gradually until a response was elicited. For the cadaveric anatomical study, eight axillae were dissected and histological samples were examined. The response of the triceps brachii muscle differed significantly between the two approaches to the radial nerve (P < 0.001), and the mean intensity of stimulation was significantly lower when the nerve was accessed above the artery (0.44 AE 0.15 mA) than below it (0.57 AE 0.17 mA) (P = 0.015). A triceps brachii motor response occurs at lower current intensity and lower needle-nerve distance when the radial nerve is accessed above the artery and over the latissimus dorsi tendon. These findings were correlated with the topography of the radial nerve in the axillary fossa. Clin. Anat. 33:578-584, 2020.

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“…In the current study, the time to onset of sensory block was 17.0 ± 10.4 mins and the duration of the block was 86.0 ± 42.9 mins with 7.5 ml of bupivacaine 0.5%. In another study, it has been reported that as the LA volume was decreased, so the duration of the block decreased and this shows that blocks applied with low volumes of LA could be selected for day-patient surgical interventions [ 20 ]. However, it should be kept in mind that the onset of a block is prolonged in these applications as it could be a disadvantage.…”

Section: Discussionmentioning

confidence: 99%

“…In the reduction of a volume that will be able to provide a block, visualization and location of the radial nerve are difficult and seems to be a restriction of the blockage. It has been proposed that differentiation of the site of the radial nerve with a nerve stimulator could be useful in decreasing the LA volume to be administered [ 20 ]. In the current study, it was determined that the use of USG guidance alone could be useful in this issue compared to conventional methods.…”

Section: Discussionmentioning

confidence: 99%

What Is the Minimum Effective Volume of Local Anaesthetic Applied in Brachial Plexus Blockage With an Axillary Approach Under Ultrasonography Guidance?

Erdogmus

Başkan²,

Zengin

et al. 2021

Cureus

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Peripheral nerve blocks with the use of ultrasonography (USG) allow visualisation of both the structures and nerves and make the block administrations safe, quick, and comfortable. However, few publications concerning the minimum local anesthetic (LA) volume are capable of providing blocks. This study aimed to find the minimum effective LA volume in brachial plexus blockage administrations with an axillary approach accompanied by ultrasonography in hand, elbow, and forehand operations. Materials and MethodThe study included a total of 55 patients (classified as American Society of Anesthesiologists (ASA) I-II) who underwent hand surgery by administering USG-guided axillary brachial plexus blockage. The ulnar, median, and radial nerves were located, and the minimum effective LA volume was investigated starting with a total of 21 ml of bupivacaine 0.5%. After accomplishing the blockage, the volume was decreased by 0.5 ml for each nerve. Block administration time, block onset times, anesthesia times, and time to first analgesic requirement were recorded. ResultsThe minimum effective LA volume for each nerve was 2.5 ml for a total of 7.5 ml. In comparing block administration times, there were no differences between high or low volume groups. It was found that sensory block onset time was 17 minutes for 7.5 ml and 11 minutes for 21 ml; sensory block regression time was six hours for 7.5 ml and 10.4 hours for 21 ml, respectively. This regression was statistically significant. The first analgesic requirement was 5.8 -16.6 hours, respectively, for each group. ConclusionIn the administration of an USG-guided axillary block, sufficient anesthesia can be achieved by administering 2.5 ml of bupivacaine 0.5% for each nerve. However, it might be kept in mind that motor and sensory block onset time will be extended and regression time and time to the first analgesic requirement will be shorter with this volume. In addition, more advanced studies must be done for the determination of the optimum volume which can be used.

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

Abstract: : The radial nerve uncommonly lies immediately deep to the axillary artery. It is frequently located on the caudad side of the artery.

Cited by 13 publications

References 13 publications

Minimum volume of local anaesthetic required to surround each of the constituent nerves of the axillary brachial plexus, using ultrasound guidance: a pilot study

Minimum volume of local anaesthetic required to surround each of the constituent nerves of the axillary brachial plexus, using ultrasound guidance: a pilot study

“Triceps Brachii Muscle Response to Neurostimulation of the Radial Nerve during Axillary Plexus Blockade: Clinical, Anatomical and Histological Correlation”

What Is the Minimum Effective Volume of Local Anaesthetic Applied in Brachial Plexus Blockage With an Axillary Approach Under Ultrasonography Guidance?

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