What Is the Minimum Effective Volume of Local Anaesthetic Applied in Brachial Plexus Blockage With an Axillary Approach Under Ultrasonography Guidance?

Abstract

Peripheral nerve blocks with the use of ultrasonography (USG) allow visualisation of both the structures and nerves and make the block administrations safe, quick, and comfortable. However, few publications concerning the minimum local anesthetic (LA) volume are capable of providing blocks. This study aimed to find the minimum effective LA volume in brachial plexus blockage administrations with an axillary approach accompanied by ultrasonography in hand, elbow, and forehand operations. Materials and Method The study included a total of 55 patients (classified as American Society of Anesthesiologists (ASA) I-II) who underwent hand surgery by administering USG-guided axillary brachial plexus blockage. The ulnar, median, and radial nerves were located, and the minimum effective LA volume was investigated starting with a total of 21 ml of bupivacaine 0.5%. After accomplishing the blockage, the volume was decreased by 0.5 ml for each nerve. Block administration time, block onset times, anesthesia times, and time to first analgesic requirement were recorded. Results The minimum effective LA volume for each nerve was 2.5 ml for a total of 7.5 ml. In comparing block administration times, there were no differences between high or low volume groups. It was found that sensory block onset time was 17 minutes for 7.5 ml and 11 minutes for 21 ml; sensory block regression time was six hours for 7.5 ml and 10.4 hours for 21 ml, respectively. This regression was statistically significant. The first analgesic requirement was 5.8 - 16.6 hours, respectively, for each group. Conclusion In the administration of an USG-guided axillary block, sufficient anesthesia can be achieved by administering 2.5 ml of bupivacaine 0.5% for each nerve. However, it might be kept in mind that motor and sensory block onset time will be extended and regression time and time to the first analgesic requirement will be shorter with this volume. In addition, more advanced studies must be done for the determination of the optimum volume which can be used.