Ultrasound-Guided Subparaneural Axillary Block in Sub-Saharan Africa: A Prospective Multicenter Study and Review of Literature

Abstract

Context: Subparaneural injection (under the nerve sheath) has reduced the onset of action and the effectiveness of local anesthetics in sciatic blocks. The objective of this work was to assess the effectiveness of this technique in axillary blocks in two hospitals in France and Gabon. Method: From January 1 to February 28, 2019, patients were included for upper limb surgery under xylocaine or Ropivacaine. The installation time, effectiveness, occurrence of paresthesia, and vascular breaches were assessed. Results: 141 patients were included, mostly male (64.55%), with an ASA 1 score (46.1%), hand surgery predominated (95%) most often performed as scheduled surgery (68.1%). Block was performed by the anesthesiologist in 39% of patients and by the anesthesiologist student in 61% of patients. The success rate was 88.66% with an installation time of 15 min, some paresthesias were noted. Despite the lack of expertise from a Gabonese hospital center, the data were compared to the literature. Conclusion: Ultrasound-guided subparaneural injection axillary block is an effective, safe technique with a rapid learning curve.