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Chapter 31E. Ultrasound-Guided Axillary Brachial Plexus Block

Which of the following is not an indication for an axillary brachial plexus block?

A. Shoulder arthroscopy

B. Carpal tunnel release

C. Elbow arthroscopy

D. Osteosynthesis of the radius

A is correct. The axillary nerve is not blocked because it departs from the posterior cord more proximally in the axilla. Therefore the skin over the deltoid muscle is not anesthetized and a shoulder arthroscopy is not a good indication for an axillary brachial plexus block.

B is incorrect. For a carpal tunnel release the medial and ulnar nerves need to be anesthetized; these are blocked in the axillary brachial plexus block. However a forearm block may be more appropriate when only a carpal tunnel release is intended.

C is incorrect. The radial and musculocutaneous nerves must be blocked for an elbow arthroscopy. The axillary brachial plexus block is an appropriate locoregional technique.

D is incorrect. The radial and musculocutaneous nerves are blocked by the axillary brachial plexus block, which is appropriate for the osteosynthesis of the radius.

Which of the following statements is true regarding ultrasound-guided axillary brachial plexus block?

A. The identification of all the individual nerves is absolutely necessary in performing an axillary brachial plexus block.

B. Three muscles surround the neurovascular axillary bundle: the biceps, the coracobrachialis, and the conjoined tendon of the teres major and latissimus dorsi muscle.

C. The axillary brachial plexus block gets its name from the main nerve that gets anesthetized.

D. A perivascular approach alone is insufficient to get a good surgical axillary brachial plexus block.

B is correct. The bicep muscles form the anterior and superficial edge, the wedge-shaped coracobrachialis forms the anterior and deep edge, and the conjoined tendon of the teres major and the latissimus dorsi forms the medial and posterior edge of the compartment.

A is incorrect. Although individual nerves can usually be identified, this is not absolutely necessary because the deposition of local anesthetic around the axillary artery is sufficient for an effective block.

C is incorrect. The block gets its name from the approach and not from the axillary nerve, which itself is not blocked because it departs from the posterior cord more proximally in the axilla.

D is incorrect. The perivascular approach of the axillary brachial plexus block is a simple injection of local anesthetic deep to the artery, at the 6 o’clock position, ...

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