Axillary blockage

The axillary blockade (also axillary brachial plexus blockade , axillary plexus anesthesia ) is a regional anesthetic procedure that enables surgical interventions on the arm. The nerves of the brachial plexus ( median nerve , ulnar nerve , radial nerve , musculocutaneous nerve ) are reversibly blocked by injecting local anesthetics in the armpit area . The axillary blockade is a relatively simple procedure that has few side effects. A disadvantage compared to the infraclavicular plexus block is the partially insufficient elimination of the innervation area of ​​the radial nerve (" radial gap "), but there is no risk of causing a pneumothorax .

application areas

The axillary plexus block enables operations on the lower (distal) upper arm, elbow, forearm and hand. It can also be used in pain therapy , for example in neuralgia , CRPS or phantom pain . During the puncture, a catheter is often inserted through which anesthetics can be continuously injected.

Contraindications are infections or tumors in the arm area, broken bones as well as rejection or lack of cooperation by the patient. Disorders of blood coagulation or taking anticoagulant drugs represent relative contraindications.

execution

Puncture site of the axillary block over the axillary artery. Course of artery and nerves, location of elimination.

The patient's arm is abducted by 90 ° in the shoulder and bent at the elbow joint so that the hand is next to the head. It is carried out under sterile conditions. The puncture site is located above the axillary artery (see figure).

The identification of the nerves in the armpit can be done by different approaches. Usually the search is carried out with the help of a nerve stimulator, which is connected to the end of the puncture cannula. The position of the needle tip near the nerves is shown by muscle twitching in the forearm. Also, ultrasound-guided puncture is possible and wins due to the high security and lower failure rate is becoming increasingly important. Another less safe method is transarterial puncture. in which the axillary artery is pierced, as well as the landmark-oriented (“blind”) puncture, which is based on a “click” when passing through the surrounding connective tissue layer.

When using the nerve stimulator, approximately 40 ml of local anesthetic is injected. Ultrasound-targeted blockages can be carried out sufficiently with 15–24 ml of local anesthetic. Longer-acting local anesthetics such as ropivacaine are preferred . In order to accelerate the onset of the effect, which takes 20-30 minutes, sometimes quick and short-acting substances such as prilocaine or mepivacaine are used in combination.

Side effects

Side effects are rare. Nerve damage can be caused by direct cannula injury or by toxic effects of local anesthetics that are accidentally injected into the nerves ( intraneurally ). This damage can be avoided by using blunt cannulas and avoiding injections in case of paresthesia during the procedure. Accidental injection into blood vessels (intravascularly) can have effects on the cardiovascular system ( bradycardia , hypotension , cardiac arrest at high doses) or the central nervous system ( seizures , impaired consciousness ).

literature

• QH De Tran, A. Clemente, J. Doan, RJ Finlayson: Brachial plexus blocks: a review of approaches and techniques. In: Can J Anaesth. , 54 (8), August 2007, pp. 662-674. Review. PMID 17666721
• D. Jankovic: Regional blockades and infiltration therapy. 3. Edition. Abw Wissenschaftsverlag, 2003, ISBN 3-936072-16-7 , pp. 106-119.
• G. Meier, J. Büttner: Compendium of peripheral blockades. 6th edition. Arcis-Verlag, 2008, ISBN 978-3-89075-177-1 .

Web links

• Axillary blockage . nerveblocks.net
• Axillary block. usra.ca, Ultrasound for Regional Anesthesia (English)

Individual evidence

1. ↑ G. Meier, H. Maurer, C. Bauereis: Axillary brachial plexus block. Anatomical investigations to improve radial nerve block. In: Anaesthesiologist. 52, 2003, pp. 535-539.
2. ↑ RH Stark: Neurologic injury from axillary block anesthesia. In: J Hand Surg. 21, 1996, pp. 391-396. PMID 8724467
3. ↑ P. Marhofer, M. Greher, S. Kapral: Ultrasound guidance in regional anesthesia. In: Br J Anaesth. 94 (1), Jan 2005, pp. 7-17. Review. PMID 15277302

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