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Keito Koh, Onishi Tatsuki, Sonoko Sakuraba, Sho Yamazaki, Hajime Yako, Takeshi Omae Department of Anesthesiology and Pain Medicine, Juntendo University Shizuoka Hospital, Izunokuni, JapanCorrespondence: Keito Koh, Department of Anesthesiology and Pain Medicine, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni-shi, Shizuoka, 410-2211, Japan, Tel +81 55 948 3111 ex 7111, Fax +81-55-947-2565, Email mad.mud@star.ocn.ne.jpPurpose: Ultrasound-guided brachial plexus block (UGBPB) has interscalene, supraclavicular, infraclavicular, and axillary approaches. The axillary block is considered to be the safest and with fewer adverse events compared to the interscalene (eg, phrenic nerve block, spinal cord or vertebral artery puncture) and supraclavicular (eg, pneumothorax). However, with regard to postoperative neurological symptoms (PONS), it is controversial whether its incidence after an axillary block was higher than that after non-axillary approaches”. In this study, we investigated whether the incidence of a neuropathy after an axillary block was higher than that after non-axillary approaches.Patients and Methods: This was a single-center, retrospective cohort study. All UGBPBs were performed under general anesthesia between January 2014 and March 2020. The outcomes included the overall incidence of PONS and neuropathies for axillary and non-axillary approaches. The etiology, symptoms, and outcomes of patients were investigated.Results: Of the 992 patients, 143 (14%) and 849 (86%) were subjected to axillary and non-axillary approaches, respectively. Among 19 cases (19.2:1000; 95% confidence interval [CI], 18.2– 20.1) of PONS, four (4.0:1000; 95% CI, 3.8– 4.2) were neuropathies attributed to the UGBPB, three (21.0:1000; 95% CI, 18.1– 23.8) to the axillary and one (2.8:1000; 95% CI, 2.6– 3.1) to non-axillary approaches. The incidence of neuropathies after an axillary block was significantly higher than that after non-axillary approaches (P = 0.005).Conclusion: The incidence of neuropathies after US-guided axillary block under general anesthesia was significantly higher than that after non-axillary approaches.Keywords: ultrasound, brachial plexus block, axillary block, neuropathy, nerve injury |
