S Sia M Bartoli. Reg Anes Pain Med 2001: 26(1): 12-16.

Reviewed by: R. Prasad, MD

Summary:

• Compared 2 axillary techniques - looking for 4 nerves vs. looking for 3 (skip ulnar, which in their experience is hardest to locate)
• Group 3: faster (5 vs. 8 min), with less pain (VAS 8 vs. 13). Onset (15-16min) and success (90-92%) similar.

• Used mix of lido 2%, bupiv 0.5%. 6cc musculocutaneous n, 10 cc for other nerves. Group 3: 20 cc for Radial N.
• 2" stimulating needle, current 0.5mA
• Axillary artery palpated at level of pectoralis major crossing the axilla

• Have only tried multiple injection technique high in axilla a few times - not entirely satisfied with it (diff to find all nerves sometimes)
• This would seem to be a nice alternative - counts on spread of injectate from Radial to Ulnar N. Faster, with less pain (although the small differences shown are probably not clinically important)
• As always, should be done in holding area not in OR.