Background and Aims Axillary block is performed at the level of the terminal nerves of brachial plexus, which have a close relation with axillary artery (AA) and veins. Knowledge about normal and anatomic variants of AA is important for this block, since variations of the terminal end of the AA can occur in 14% of the cases. The main variation is a bifurcation in two major stems, instead of continuing as brachial artery.

Methods 62 year-old-male, with left Dupuytren’s contracture, presented for inpatient palmar fasciectomy. He had a previous history of a severe OSA with CPAP, insulin-dependent type 2 DM and psoriatic arthritis, classified as ASA 3. Regional anesthesia was considered more adequate for this case. A single shot axillary block, guided by ultrasound (linear probe) was performed, with a 22G nerve stimulation needle. During the scanning, a bifurcation of left axillary was noticed. Terminal nerves surrounded both divisions, so the block was conducted by avoiding the vascular structures. On the right side, axillary artery continued as brachial artery. A total volume of 20 mL of 0,5% ropivacaíne was injected. The patient did not develop any complication, especially related to vascular punction. The procedure was uneventful. Postoperative analgesia was effective.

Results Anatomic vascular variations of the arm are not so rare. US improved safety and efficacy, detecting axillary artery variation and avoiding injection of local anaesthetic into vascular system.

Conclusions We report a case which enhances the guidance of ultrasound (US) during peripheral block, especially when vascular variations are considered.