Ultrasound-guided anaesthesia of the axillary brachial plexus: efficacy of multiple injection approach

High resolution ultrasound is a new method for detecting anatomical structures in the axilla. The visualisation of nerves can improve the quality of nerve blocks. The aim of our study was to investigate the feasibility of hand held ultrasound to perform sonographically guided blockades of the axillary plexus. We investigated 46 patients routinely scheduled for forearm and hand surgery (ASA physical status I-IV, age range 19 - 89 years, mean 47). The axilla was examined using a handheld ultrasound system with a 10 MHz linear array probe. The median, ulnar, radial and musculocutaneus nerve were visualised by ultrasound. Selective nerve blockade was performed under sonographic guidance. Real time monitoring of the local anaesthetic spread was performed. Time required to perform the block and onset times of anaesthesia were documented. Complete anaesthesia of the brachial plexus was achieved in all cases. The average time to perform the block was 5 minutes (SD 2 min). Onset time for the block was 7 minutes (SD 3 min). Performing axillary nerve blockade using ultrasound guidance provides excellent anaesthesia and fast onset times.