Article Text

Download PDFPDF
Selective Ulnar Nerve Localization Is Not Essential for Axillary Brachial Plexus Block Using a Multiple Nerve Stimulation Technique
  1. Salvatore Sia, M.D. and
  2. Maurizio Bartoli, M.D.
  1. From the Department of Anesthesiology, Centro Traumatologico Ortopedico, Firenze, Italy.
  1. Reprint requests: Salvatore Sia, M.D., Via Santelli, 41, 50134 Firenze, Italy.


Background and Objectives The multiple-injection technique for axillary block, in which the 4 distal nerves of the plexus are located by a nerve stimulator and separately injected, has been shown to produce a rapid onset and a high success rate. However, this technique may be more difficult and time consuming than other axillary block methods. A simplified multiple-nerve stimulation technique, in which the ulnar nerve was not located, was compared in the present double-blind study to the 4-injection approach.

Methods Eighty-four patients were randomly allocated to 2 groups. In group IV, all 4 distal nerves of the plexus were located by a nerve stimulator and injections made. In group III, all the nerves but the ulnar were located and injections made. The block was defined as complete when analgesia was present in all the sensory areas distal to the elbow.

Results The time to perform the block was shorter in group III (5 ± 2 v 8 ± 3 minutes; P < .001). Block performance pain was lower in group III patients (8 ± 2 v 13 ± 2 mm; P < .001). The onset time (15 ± 6 v 16 ± 7 minutes) and the frequency (90% v 92%) of complete block were not different between the groups.

Conclusions A triple-injection method of axillary block in which the ulnar nerve was not purposely located provides a spread and a latency of sensory block equal to that obtained with a 4-injection technique. A shorter performance time is an advantage of this approach.

  • Anesthetic techniques
  • Regional
  • Brachial plexus
  • Axillary approach
  • Nerve stimulation

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.