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Axillary Brachial Plexus Block Using Peripheral Nerve Stimulator: A Comparison Between Double- and Triple-Injection Techniques
  1. Salvatore Sia, M.D.,
  2. Antonella Lepri, M.D. and
  3. Paolo Ponzecchi, M.D.
  1. From the Department of Anesthesiology, Centro Traumatologico Ortopedico, Azienda Ospedaliera Careggi, Firenze, Italy.
  1. Reprint requests: Salvatore Sia, M.D., Via Santelli, 41, 50134 Firenze, Italy. E-mail: salvsia{at}


Background and Objectives The multiple-injection technique for axillary block, in which the main 4 nerves of the plexus are located by a nerve stimulator and separately injected, has been shown to produce a high success rate. However, this technique may prove to be more difficult and time-consuming than other methods. Therefore, a simplified technique, with a reduced number of injections, might be desirable. A comparison between 2- and 3-injection techniques was made in the present double-blind study.

Methods One hundred patients were randomly allocated to 2 groups. In group 3N, the radial, median, and musculocutaneous nerves were located by a nerve stimulator and injections made. In group 2N, the radial and median nerves were located and injections made. Forty milliliters of local anesthetic was used.

Results A greater success rate for anesthetizing the musculocutaneous nerve was found in group 3N (98% v 80%; P < .005). No differences between the groups were found in the success rate for blocking the radial, median, and ulnar nerves. The rate of complete block (all the sensory areas distal to the elbow) was 90% in group 3N and 76% in group 2N. The time to perform the block was shorter in group 2N (5 ± 1 v 6 ± 1 minutes; P < .001).

Conclusions The 2-injection technique offers a success rate in blocking the 3 nerves innervating the hand similar to that obtained with the 3-injection technique. The latter approach should be considered when the musculocutaneous nerve distribution is involved in the surgical area.

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

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