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

Abstract

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.

Investigation of infraclavicular block success using the perfusion index: a randomized clinical trial

“…USG allows direct and real-time visualization of nerve structures, needle position, and LAs and is therefore prevalently used in peripheral nerve blocks. In studies where block implementations have been carried out under USG guidance, the use of USG was associated with lower use of LA, higher block success rates, lower complication rates, and lower opioid consumption [ 6 , 7 ]. In this study, to reduce complication rates and increase the success of the block, USG and NS were used together for guidance.…”

Comparison of perineural brachial plexus block and proximal perivascular block in ultrasound-guided axillary brachial plexus block

“…González et al [10] reported a minimum effective volume of 2% lidocaine with epinephrine 5 µg/mL in 90% of patients for double-injection ultrasound-guided axillary block, 5.5 mL for MC nerve, and 23.5 mL for perivascular injection. Erdogmus et al [9] reported that the volume of 0.5% bupivacaine could decrease by 2.5 mL per nerve for a total of 7.5 mL (radial, ulnar, median nerve block), but decreasing local anesthetic dose will increase onset time and early regression of the block effect. No local anesthetic-related complications were observed in our study.…”

“…Various ultrasound injection techniques have been studied to increase the effectiveness of BPB [2,[5][6][7][8]. Ultrasound guidance not only facilitates the anesthetic procedure, but also decreases the dose of local anesthetics [9][10][11].…”

Comparison of Patient-Controlled Analgesia With Tramadol or Morphine After Video-Assisted Thoracoscopic Surgery in Geriatric Patients

“…If adequate postoperative analgesia is not administered, undesirable consequences such as atelectasis, decreased patient comfort, increased postoperative morbidity, prolonged hospital stay, and chronic pain may be encountered [6,7]. Peripheral nerve blocks are often preferred to prevent postoperative pain due to their low side effects [8]. However, intravenous analgesia is often combined with peripheral blocks to provide more effective analgesia [9].…”