Ultrasound-guided supra-axillary block as a supplement to subclavian perivascular brachial plexus block for surgeries around the elbow: A prospective feasibility study

Abstract

Background: The dermatomal area supplied by the intercostobrachial nerve (ICBN) and medial cutaneous nerve of the arm (MCNA) are not reliably blocked by currently used approaches of the brachial plexus block. This feasibility study is aimed at determining the efficacy of the novel ultrasound-guided supraaxillary block. Patients and Methods: This prospective, observational study was conducted on patients undergoing surgeries around the elbow. Sixty American Society of Anesthesiologists Physical Status I and II patients aged between 18 and 60 years were recruited. The supraaxillary block was performed in addition to the subclavian perivascular brachial plexus block in all patients. The local anesthetic (LA) mixture was prepared with 10 ml of 2% lignocaine-adrenaline, 15 ml of 0.5% bupivacaine, and 10 ml of 0.9% saline. 20 ml of the LA solution was used for supraclavicular block, and 15 ml was injected in the supra-axillary area. Results: The onset of sensory and motor block for the subclavian perivascular block was 4.30 ± 0.891 and 8.12 ± 0.872 min, respectively. The onset of the supra-axillary block was 9.50 ± 0.707 min. Only 6.67% of the patients needed additional local infiltration. Conclusion: Ultrasound-guided single-shot injection of LA in the supra-axillary area as a supplement to subclavian perivascular brachial plexus block achieved complete anesthesia for surgical procedures around the elbow by blocking the ICBN and MCNA.

Keywords

• intercostobrachial nerve
• medial cutaneous nerve
• peripheral nerve block
• regional anesthesia
• upper limb blocks