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Perivascular axillary brachial plexus block and patient positioning: the influence of a lateral, head‐down position
Author(s) -
Orlowski O.,
Bullmann V.,
Vieth V.,
Filler T.,
Osada N.,
Van Aken H.,
Weber T. P.
Publication year - 2006
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.2006.04618.x
Subject(s) - medicine , mepivacaine , supine position , brachial plexus , anesthesia , blockade , trendelenburg position , nerve block , brachial plexus block , head down tilt , plexus , anatomy , surgery , bupivacaine , receptor , bed rest
Summary The aim of this study was to examine the effect of a 20° Trendelenburg position on the blockade of nerves that exit the brachial plexus proximally in patients undergoing single‐injection axillary brachial plexus block. After a pilot study of eight cadavers suggested that a head‐down and lateral position would encourage the proximal spread of local anaesthetic, 72 patients undergoing elective surgery were divided into two equal groups: a Supine group and a Modified Position group (lateral position, 20° head‐down tilt). Patients were left in the allocated position for 30 min after an axillary block had been performed with alkalinised mepivacaine 1% 49.5 ml. Sensory and motor blockade evaluation showed that there was a significantly higher proportion of axillary nerve (76% vs. 0%, p < 0.001), thoracodorsal nerve (86% vs. 0%, p < 0.001) and subscapular nerve (89% vs. 0%, p < 0.001) blockade in the Modified Position group. Sensory block of the radial nerve was also improved by the modified position (100% vs. 86%, p < 0.05).