Neuropathies Following an Ultrasound-Guided Axillary Brachial Plexus Block

Abstract

Purpose

Ultrasound-guided brachial plexus block (UGBPB) has interscalene, supraclavicular, infraclavicular, and axillary approaches. The axillary block is considered to be the safest and with fewer adverse events compared to the interscalene (eg, phrenic nerve block, spinal cord or vertebral artery puncture) and supraclavicular (eg, pneumothorax). However, with regard to postoperative neurological symptoms (PONS), it is controversial whether its incidence after an axillary block was higher than that after non-axillary approaches”. In this study, we investigated whether the incidence of a neuropathy after an axillary block was higher than that after non-axillary approaches.

Patients and Methods

This was a single-center, retrospective cohort study. All UGBPBs were performed under general anesthesia between January 2014 and March 2020. The outcomes included the overall incidence of PONS and neuropathies for axillary and non-axillary approaches. The etiology, symptoms, and outcomes of patients were investigated.

Results

Of the 992 patients, 143 (14%) and 849 (86%) were subjected to axillary and non-axillary approaches, respectively. Among 19 cases (19.2:1000; 95% confidence interval [CI], 18.2–20.1) of PONS, four (4.0:1000; 95% CI, 3.8–4.2) were neuropathies attributed to the UGBPB, three (21.0:1000; 95% CI, 18.1–23.8) to the axillary and one (2.8:1000; 95% CI, 2.6–3.1) to non-axillary approaches. The incidence of neuropathies after an axillary block was significantly higher than that after non-axillary approaches (P = 0.005).

Conclusion

The incidence of neuropathies after US-guided axillary block under general anesthesia was significantly higher than that after non-axillary approaches.

Keywords:

• ultrasound
• brachial plexus block
• axillary block
• neuropathy
• nerve injury

Abbreviations

BPB, brachial plexus block; US, ultrasound; NS, nerve stimulation; UGBPB, ultrasound-guided brachial plexus block; PONS, postoperative neurological symptom; IPM, injection pressure monitoring; ASRA, American Society of Regional Anesthesia and Pain Medicine.

Acknowledgments

The authors would like to thank the anesthesiology medical staff of Juntendo University Hospital for their assistance and Honyaku Center Inc. for English language editing.

Disclosure

The authors report no conflicts of interest in this work.