Axillary Brachial Block

  • Most commonly performed secondary to safety and relative ease
  • It is suitable for surgery to the forearm, wrist and hand, though the radial side of the forearm is sometimes missed 
  • This can be addressed by blocking the musculocutaneous nerve separately by injecting local anesthetic into the belly of the coracobrachialis muscle, just superior to the pulsation of the axillary artery and at 90° to the skin


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Anatomy

  • Lateral to the artery lies the median nerve
  • On the other side of the axillary artery (medial, anatomically) is the radial nerve
  •  The ulnar nerve lies more medially 

Positioning

  • The patient is supine with the target arm abducted, supinated and flexed at the elbow. 
  • The hand is placed besides or behind the patient’s head and supported by a pillow
  • The probe is placed transversely against the upper, inner arm just below the axilla so that the beam will cross the suspected path of the axillary artery
  •  The artery is identified by it’s resistance to collapse with pressure

Indications

Provides anesthesia

  • For surgery of the hand
  • Wrist
  • Forearm

References

and Interesting Articles...

  • Satapathy AR, Coventry DM. Axillary brachial plexus block. Anesthesiol Res Pract. 2011;2011:173796. doi: 10.1155/2011/173796. Epub 2011 May 22. PMID: 21716725; PMCID: PMC3119420. Link
  • Janjua MS, Pak A. Axillary Block. [Updated 2022 Jun 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537201/

  • Sia S, Lepri A, Ponzecchi PAxillary Brachial Plexus Block Using Peripheral Nerve Stimulator: A Comparison Between Double- and Triple-Injection TechniquesRegional Anesthesia & Pain Medicine 2001;26:499-503. Link


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