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Local and Regional Anaesthesia

Axillary plexus block according to Weber is more effective than Büttner's method in supine position: A-435

Orlowski, O.; Bullmann, V.; Filler, T.; Van Aken, H.; Weber, T. P.

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European Journal of Anaesthesiology: May 2005 - Volume 22 - Issue - p 115
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Background and Goal of Study: Using the axillary brachial plexus block (AP) according to Weber with lateral positioning combined with 20° Trendelenburg positioning it is possible to reach more proximal nerves (1) than with Büttner's method in supine position (2). It is not clear whether the two methods are equally efficient. Therefore, in this prospective, randomized, single-blind study we compared the sensory and motoric quality, spread and time to obtain a complete block, tourniquet, frequency of supplemented nerve blocks and the need for general anaesthesia.

Materials and Methods: After a positive vote of the local Ethics Committee 108 patients undergoing hand surgery were separated into 2 groups: B (Büttner) and W (Weber). The block was performed (using a nerve stimulator) with 45 mL mepivacaine 1% (MEPI1%) and NaHCO3 (1:10). The musculocutaneous nerve was separately blocked with 5mL MEPI1%. Only in group W patients were positioned onto the anaesthetized side for 30 minutes according to Weber. Incomplete blocks were supplemented 30 min after the initial block.

Results: A greater success rate of a complete sensory block was found in group W (88,9%* vs. 71,3%). Incomplete blocks were more successfully supplemented in group W (8,3%* vs. 19,4%). The need for general anaesthesia was lower in group W (2,8%* vs. 9,3%). Only in group W a complete sensory block of axillary nerve (NA) occurred (65,7%** vs. 0,0) and 21,3% vs. 13,9% of incomplete sensory block was found. Motor blocks of the NA (74,1%** vs. 0,0), of the thoracodorsal nerve (NT) in (64,8%** vs. 0,0), and the subscapular nerve (NS) (74,1%** vs. 0,0), occurred only in group W.

Statistics: Chi-quadrat-test corrected by Yates (p < 0.05; sign. = *, p < 0.001; sign. = **).

Conclusion: The axillary brachial plexus block according to Weber with positioning onto the anaesthetized side reduces the need for supplemented nerve blocks and the need for general anaesthesia, when compared to the method in supine position according to Büttner.

References:

1 Orlowski O. Reg Anesth Pain Med 2004; Vol. 29: No. 5: Suppl. 2: 14.
2 Büttner J. Reg Anaesth 1988 Jan; 11: 7-11.
© 2005 European Society of Anaesthesiology