Axillary Brachial Plexus Block: Regional Anesthesia – Flashcards
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What are the indications for an Axillary brachial plexus block?
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Forearm, and hand surgery. Blocks below the Elbow, forearm and hand
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What is the goal for the axillary brachial plexus block?
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Local Anesthetic spread around the axillary artery "The goal for the axillary brachial plexus block is injection of the local anesthetic around the axillary artery as median, ulnar and radial nerve are all located within the neurovascular sheath. A separate injection is needed to block the musculocutaneous nerve" Hedzik Chp 15, p. 192
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What are the surface landmarks for the axillary block?
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(1) pectoralis major insertion site (2) coracobrachialis muscle. (3) axillary artery (pulse)
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what nerve runs inside the coracobrachialis muscle?
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musculocutaneous nerve.
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Is the axillary nerve blocked first or last in the Axillary brachial plexus block?
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The axillary nerve is *not blocked* in the Axillary brachial plexus block The axillary nerve departs from the posterior cord before this location
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What are the doses used in ultrasound-guided axillary Brachial Plexus Block, with 3 injection technique?
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10mL above Axillary artery 10mL below axillary artery 5mL around musculocutaneous
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Where should the transducer be placed in the ultrasound guided Axillary Block?
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short axis to arm, just distal to pectoralis major insertion
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What does the transarterial approach to the axillary block entail? (general steps)
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Transarterial technique --> not favorable because you puncture the artery --Pass through posterior wall of artery --> test dose of 3mL injected and observe for 1 minute for possible intravascular injection --Incremental injections of 5mL until 20mL of local is deposited --Withdraw needle back, blood stops, needle is in the neurovascular sheath anterior to the axillary artery --Another 3mL test dose given --Following each aspiration, 5mL of LA is injected incrementally until a total of 40mL is deposited
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When blocking all 4 branches of the brachial plexus in an axillary block, which one will you block seperately and last?
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musculocutaneous nerve. Musculocutaneous --> leaves proximal to the sheath (via lateral cord) and travels through coracobrachialis muscle
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What are the complications of an axillary block?
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Incomplete analgesia Neuropraxia Intra-arterial injection. Hematoma (nerve damage, bleeding, and infection)
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True or False: When performing an Axillary brachial plexus block, if you encounter abnormal pressure and high injection pressure you should continue to inject but much more slowly.
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False; Never inject local anesthetic when abnormal resistance (high injection pressure) is encountered on injection. Hedzik Chp 15, p. 193
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What is the first sign of a successful Axillary brachial plexus?
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The first sign of the blockade is loss of coordination of the arm and forearm muscles. Hedzik Chp 15, p. 192
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Where is the Median nerve located in relation to the Axillary Artery,
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Anterior & Medial
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Where is the Ulnar nerve located in relation to the Axillary Artery?
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Posterior & Medial
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Where is the Radial nerve located in relation to the Axillary Artery?
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Posterior & Lateral
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Where is Musculocutaneous nerve located in relation to the Axillary Artery?
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Anterior & Lateral
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Axillary Block Acceptable responses to stimulation with a nerve stimulator assisted block?
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Musculocutaneous (elbow flexion) Median (Flexion of wrist) Radial (Wrist, elbow, finger extension) Ulnar (4th finger/pointer and thumb flexion)
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Axillary Block Unacceptable response stimulation with a nerve stimulator assisted block?
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Triceps (elbow extension) --> withdraw & redirect
