Retrospective evaluation of axillary brachial plexus block by multiple nerve stimulation technique [Çoklu sinir uyari yöntemi ile uygulanan aksiller brakiyal pleksus blogunun geriye dönük degerlendirilmes]

Aim: Axillary block with multiple nerve stimulation (MNST) is a technique which provide both rapid motor block and a higher rate of success. In this study, we retrospectively evaluated block efficiency and complications during routine use of this technique. Material and Method: ASA-I/II 227 patientsundergoing hand/forearm surgery under brachial plexus blockade by MNST were evaluated retrospectively. Axillary block was performed with a 50 mm stimuplex needle and a nerve stimulator in all patients. The stimulator was set to deliver pulses at 1 mA, 2 Hz frequency and 0.1 ms- duration. N. musculocutaneous, ulnaris, radialis, medianus were separately located at the point of motor response with a stimulating current of 0.3-0.5 mA and local anaesthetic (LA) mixture was injected separately to each nerve (LA solution: equal volumes of 0.5 % upivacaine+2 % prilocaine, NMT: 40 mL). Demographic data, parameters about the blockade and complications related to the block were recorded. Neurological complications during nerve blockade were evaluated 24 hours after the blockade by phone interviews with the patients. Patient satisfaction and the performer anaesthesiologist's opinion about the block were evaluated separately. Results: Block performance time (9.9±3.4 min), onset times of motor (9.2±3.8 min), and sensory blockades (11.1±5.0 min),reversal times of motor (601.3±140.4 min) and sensory blockades (619.1±117.0 min) were recorded. Ninety four percent of the patients expressed their wish to undergo the same operation under the same anaesthetic technique in the future. Findings correlated with ethemoglobinemia was detected in two patients and neurological complications developed in two patients. Conclusion: Brachial plexus blockade by multiple stimulation technique via axillary approach was found to be safe and useful as it provided a highly successful and efficient anaesthesia with better patient satisfaction and negligible complications