Does anyone still do axillary blocks?

[Lee123]

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Any method. Does anyone still do them? If you do, when do you choose an axillary over a supraclavicular? I am only asking to see what others do and why.

 

[Gern Blansten]

Still do a large amount. Technically easy with ultrasound and very high success rate since we started doing ultrasound guided. Usually do ax for distal to the elbow and supraclavicular for upper arm/shoulder.
Infraclva seem good, I am just not as good at them due to less experience. The times I have done them, they were technically easy, just never got in the habit and ax blocks are familiar.

Used to do mostly interscalenes for shoulders, but supraclaviculars with ultrasound are easier in my hands. Sometimes the interscalene can prove elusive (in my hands). I am sure if I did more, I would become much better. If I do not use ultrasound (rare), I will do the interscalene.

 

[Noyac]

Did me last week. I still prefer the axillary block for hand surgeries.

 

[DScully]

Still happens...mostly for hand surgeries.

 

[bostonblaz]

I do them for hand and distal radial stuff if i wanna do block plus mac. I use very little local and i get faster onset

 

[HalO'Thane]

I do them in little kids (usually < 5 years old). We occasionally do polydactyly/ syndactyly surgeries for infants and small children. In those patients I am a little skittish about doing a supraclavicular block because the distance to the lung is so small. I find the ax block under US guidance much easier than an infraclavicular block. Even in a 10 kg kid with US the terminal branches of the brachial plexus can be visualized pretty nicely at the level of the axillary artery.

 

[BLADEMDA]

Still do a large amount. Technically easy with ultrasound and very high success rate since we started doing ultrasound guided. Usually do ax for distal to the elbow and supraclavicular for upper arm/shoulder.
Infraclva seem good, I am just not as good at them due to less experience. The times I have done them, they were technically easy, just never got in the habit and ax blocks are familiar.

Used to do mostly interscalenes for shoulders, but supraclaviculars with ultrasound are easier in my hands. Sometimes the interscalene can prove elusive (in my hands). I am sure if I did more, I would become much better. If I do not use ultrasound (rare), I will do the interscalene.

Agree. The peer review evidence backs up all your statements. I think you are trying to find C5, C6 and C7 under U/S for ISB. Just find 2 out of 3 and block one using at least 20-25 mls of local. Sometimes it's hard to find all 3 nerves consistently but you can find 2 out of 3 99% of the time pretty easily. Remember the difference between a supraclavicular block (above the artery for a shoulder, no need for corner pocket) and an ISB is about 3-4 cm. Simply move the probe up the neck SLIGHTLY and rotate it Slightly. Take a look below at this link: http://www.youtube.com/watch?v=Dg9BJ-32yLc&feature=related"

 

[Gern Blansten]

Agree. The peer review evidence backs up all your statements. I think you are trying to find C5, C6 and C7 under U/S for ISB. Just find 2 out of 3 and block one using at least 20-25 mls of local. Sometimes it's hard to find all 3 nerves consistently but you can find 2 out of 3 99% of the time pretty easily. Remember the difference between a supraclavicular block (above the artery for a shoulder, no need for corner pocket) and an ISB is about 3-4 cm. Simply move the probe up the neck SLIGHTLY and rotate it Slightly. Take a look below at this link: http://www.youtube.com/watch?v=Dg9BJ-32yLc&feature=related"

Thanks Blade! I can usually find it okay. It just doesn't come as easy so choose what is easier. I should probably reverse that so I can get better and faster at both.

 

[Oggg]

I had a lady with bilateral fractures, do I did ISB one side and Ax on the other. Not sure why I didnt just do infraclav. I think it was humerus and wrist fx.

 

[BLADEMDA]

I had a lady with bilateral fractures, do I did ISB one side and Ax on the other. Not sure why I didnt just do infraclav. I think it was humerus and wrist fx.

Great. She better have a good friend to wipe her arse.

No block for wrist fracture and ISB for humerus means at least one arm can now be used (partially).

 

[Gern Blansten]

Great. She better have a good friend to wipe her arse.

No block for wrist fracture and ISB for humerus means at least one arm can now be used (partially).

Sounds like both arms are out of commission anyway...

 

[Dejavu]

I do ax blocks frequently, or rather I watch residents and fellows do them, mostly, although sometimes I get lucky and I get to do my own. We do both single shot blocks (several times a week) as well as being asked to place postop ax catheters on elbow surgery pts when they will be in constant passive motion machines for a couple of days to help with pain control.

I also teach nerve stim technique, with equal success.

Hell, call me a dinosaur, I still teach transarterial blocks. There, I said it.

I will even claim a high success rate with that old technique.

 

[Gern Blansten]

I do ax blocks frequently, or rather I watch residents and fellows do them, mostly, although sometimes I get lucky and I get to do my own. We do both single shot blocks (several times a week) as well as being asked to place postop ax catheters on elbow surgery pts when they will be in constant passive motion machines for a couple of days to help with pain control.

I also teach nerve stim technique, with equal success.

Hell, call me a dinosaur, I still teach transarterial blocks. There, I said it.

I will even claim a high success rate with that old technique.

We used to do a lot of transarterial techniques and had pretty high success rate with them as well. With ultrasound, it just seems as though we NEVER get a failed block. Of course, it is not never, but it seems that way sometimes.

 

[imfrankie]

I do them in little kids (usually < 5 years old). We occasionally do polydactyly/ syndactyly surgeries for infants and small children. In those patients I am a little skittish about doing a supraclavicular block because the distance to the lung is so small. I find the ax block under US guidance much easier than an infraclavicular block. Even in a 10 kg kid with US the terminal branches of the brachial plexus can be visualized pretty nicely at the level of the axillary artery.

Sweet. You do PNB for club foot work?

 

[Lee123]

Hell, call me a dinosaur, I still teach transarterial blocks. There, I said it.

I will even claim a high success rate with that old technique.

I always did trans-art blocks and aimed the needle high up. Almost always got the M.C. nerve with it. Never had one fail. Haven't done one in a while with the SupraCl. blocks.

 

[HalO'Thane]

Sweet. You do PNB for club foot work?

Our group often does some sort of block if it is an extensive club foot procedure. If the child is small enough and I think there are no contraindications I find it easier just to place a caudal and add 1 mcg/kg of clonidine. As you know, many of these kids have had previous back surgeries or shunts placed, so I often avoid sticking a needle in the back and will place an ultrasound guided pop fossa block and saphenous field block for post op pain control.

 

[IN2B8R]

Great. She better have a good friend to wipe her arse.

No block for wrist fracture and ISB for humerus means at least one arm can now be used (partially).

ROFL