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A Prospective, Randomized Comparison Between Perivascular and Perineural Ultrasound-Guided Axillary Brachial Plexus Block
  1. Francisca Bernucci, MD,
  2. Andrea P. Gonzalez, MD,
  3. Roderick J. Finlayson, MD, FRCPC and
  4. De Q.H. Tran, MD, FRCPC
  1. From the Department of Anesthesia, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
  1. Address correspondence to: De Q.H. Tran, MD, FRCPC, Montreal General Hospital, Department of Anesthesia, 1650 Ave Cedar, D10-144,Montreal, Quebec, Canada H3G 1A4 (e-mail: de_tran{at}


Background This prospective, randomized, observer-blinded study compared perivascular (PV) and perineural (PN) ultrasound-guided axillary brachial plexus block (AXB) for upper extremity surgery.

Methods Fifty patients were randomly allocated to receive a PV (n = 25) or PN (n = 25) ultrasound-guided AXB. The local anesthetic agent (lidocaine 1.5% with epinephrine 5 μg/mL) and total volume (32 mL) were identical in all subjects. For both groups, the musculocutaneous nerve was first located and then anesthetized using 8 mL. Subsequently, in the PV group, 24 mL was deposited dorsal to the axillary artery (6-o’clock position). In contrast, for the PN group, the median, ulnar, and radial nerves were individually anesthetized with volumes of 8 mL. During the performance of the block, the performance time, number of needle passes, and complications (vascular puncture, paresthesia) were recorded. Subsequently, a blinded observer assessed the onset time, block-related pain scores, and success rate (surgical anesthesia). The main outcome variable was the total anesthesia-related time (sum of performance and onset times).

Results No differences were observed between the 2 groups in terms of success rate (92%–96%), total anesthesia-related time (27.1–29.0 min), and block-related pain scores. However, the PV technique required fewer needle passes (3.5 [SD, 1.0] vs 8.2 [SD, 2.2]; P = 0.000) as well as a shorter performance time (8.2 [SD, 2.3] vs 15.7 [SD, 3.2] min; P = 0.000) and was associated with a lower incidence of paresthesia (8 vs 52%; P = 0.001). In contrast, the PN technique resulted in a quicker onset time (13.8 [SD, 7.0] vs 18.9 [SD, 7.0] min; P = 0.021) and a decreased incidence of vascular puncture (0 vs 24%; P = 0.01).

Conclusions Perivascular and PN ultrasound-guided AXBs result in comparable success rates and total anesthesia-related times. Because of fewer needle passes and a shorter performance time, the PV technique provides a simple alternative for ultrasound-guided AXB.

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  • None of the authors received funding for this study.

  • The authors declare no conflict of interest.