Periarterial Injection Versus Multiple Periveural Injection

The Ultrasound Guided Periarterial Injection Technique To Axilary Brachial Plexus Block Versus Perineural Multiple InjectionTechnique

In the transarterial technique for axillary brachial plexus block, the axillary artery is intentionally punctured to indicate placement of the needle within the neurovascular sheath; local anesthetic is then injected deep and superficial to the axillary artery.

To lessen the risk for hematoma and intravascular injection, several modifications, such as the multi-injection perineural technique, have become popular. These techniques require a high degree of technical skill and multiple needle passes, and also carry potential for injury. In this study, the investigators will compare an ultrasound-guided equivalent of the transarterial technique (periarterial injections) to a commonly used multi-injection perineural technique.

The needle will be inserted in the axillary fossa in-plane (cranial to caudal) close to the intersection of the pectoralis and biceps muscles. Two separate injections of local anesthetic will be made deep and superficial to the axillary artery

The median, ulnar and radial nerves will be identified by ultrasound. Local anesthetic will be injected adjacent to each nerve

Inclusion criteria: - Patients (ASA physical status I-III) scheduled to undergo hand or wrist surgery under axillary brachial plexus block Exclusion criteria: Patients with pre-existing neuropathy Patients with allergy to local anesthetics Patients with prior surgery in the ipsilateral axilla Pregnant patients Patients with difficulties in communication