Anesthesia & Analgesia:
Letters to the Editor: Letters & Announcements
Orthopaedic Anaesthesia Unit; Rigshospital; Copenhagen; Denmark; firstname.lastname@example.org
To the Editor:
Fuzier et al. (1) recently compared double-injection axillary brachial plexus block with midhumeral block for emergency surgery of the upper arm. They define secondary block effectiveness as a surgical analgesia after supplementary blocks, and report 100% secondary block effectiveness in both groups. However, their Table 2 showed 93% effectiveness in the axillary block group (80% successful primary block and 13% supplemented) and 98% effectiveness in the midhumoral group (91% successful primary block and 7% supplemented). It is not clear why these numbers do not add up to 100%.
It is also unclear why the authors concluded that a double-injection axillary block was superior to a midhumeral block. More axillary blocks needed supplementary blocks. Analgesia of the musculocutaneous nerve was significantly poorer with axillary blocks. The onset time was similar. The only advantage of axillary block was patients’ shorter performance time and higher block tolerance. As shown by Kinirons et al., (2) discomfort during block placement can be reduced with sedation.
Zbigniew J. Koscielniak-Nielsen, MD, PhD, FRCA
Orthopaedic Anaesthesia Unit
1. Fuzier R, Fourcade O, Pianezza A, et al. A comparison between double-injection axillary brachial plexus block and midhumeral block for emergency upper limb surgery. Anesth Analg 2006;102:1856–8.
2. Kinirons BP, Bouaziz H, Paqueron X, et al. Sedation with sufentanil and midazolam decreases pain in patients undergoing upper limb surgery under multiple nerve block. Anesth Analg 2000;90:1118–21.