Transarterial Brachial Plexus Anaesthesia for Upper Limb Surgery: Safety and Efficacy Without Nerve Stimulator

Abstract

Objective: We present our experience with the transarterial brachial plexus anaesthesia as a technique of choice for upper limb procedure in developing countries where nerve stimulator may not be readily available.
Methods: For all consenting patients, the axillary block was instituted using a 23G hypodermic needle and injection of 1.5% lidocaine with adrenaline (40 – 50mL). Sociodemographic data, the quality of anaesthesia at commencement of surgery, time to request for first postoperative analgesia, surgeons and patients satisfaction with quality of anaesthesia were obtained.
Results: 43 patients with a mean age of 33.4 ± 15.8yr were studied. The site of surgical procedures included forearm (48.8%), hand (20.9%), wrist (16.3%) and distal humerus/elbow (14.0%). The block performance time was 6.7 ± 2.5min, block latency (20.8 ± 7.9min), primary block effectiveness (81.4%) and with supplementation 90.7%.
Conclusion: The transarterial approach without neurostimualtion is simple and safe. It appears as a good alternative to general anaesthesia for upper limb surgery in resource-poor setting.

Key words: axillary block, transarterial approach, brachial plexus anaesthesia, outcome