Axillary BPB Position
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The Axillary Brachial Plexus Block (ABPB) is a cornerstone technique in regional anesthesia, providing effective surgical anesthesia and postoperative analgesia for the upper extremity. Its strategic importance lies not only in its reliability for procedures involving the elbow, forearm, and hand but also in its exceptional safety profile. This key differentiator—specifically, the avoidance of major complications like pneumothorax or phrenic nerve palsy common to more proximal approaches—has cemented its role as an indispensable tool in modern anesthetic practice, particularly for day-case surgery.
The technique has a rich history, first described by the pioneering surgeon William Halsted in 1884, who used cocaine injected under direct vision. Its evolution continued with the first percutaneous method performed by G. Hirschel in 1911, though it only gained widespread popularity following a key publication by Burnham in 1959. Since then, the axillary block has become one of the most frequently performed peripheral nerve blocks, with its enduring prominence rooted in a consistently low incidence of major adverse events. This guide will provide a detailed overview of the clinical applications, anatomical basis, and procedural execution of this vital technique.
Proper patient selection is critical to ensuring the efficacy and safety of the axillary block. A thorough assessment of the indications for the procedure, balanced against any potential contraindications, is a non-negotiable first step in the clinical workflow. This evaluation ensures that the block is appropriate for the planned surgery and that patient-specific risk factors are identified and mitigated.
| Primary Indications | Contraindications |
|---|---|
| The axillary block provides highly reliable anesthesia and analgesia for a variety of clinical scenarios:- Surgical procedures at or distal to the elbow.<br>- Anesthesia for closed reduction of fractures at or distal to the elbow.<br>- Promoting vasodilation in the upper limb, which is beneficial after reimplantation or reconstructive surgery.<br>- Management of chronic pain conditions affecting the distal upper extremity, such as complex regional pain syndrome. | Absolute Contraindications<br>- Patient Refusal: A patient's decision to decline the procedure is an absolute contraindication.<br>- Local Infection: The presence of an active infection or open wound at the proposed injection site in the axilla prohibits the block due to the risk of spreading the infection.<br><br>Relative Contraindications<br>- Coagulopathy/Anticoagulation: Patients with bleeding disorders or those on anticoagulant therapy are at an increased risk of hematoma formation in the highly vascular axilla.<br>- Pre-existing Nerve Damage: A history of peripheral neuropathy or existing neurological deficits requires careful consideration, as there may be an increased risk for nerve injury.<br>- Severe Pulmonary Disease: While the axillary block is preferable to more proximal blocks in these patients, any regional technique should be approached with caution in individuals with compromised respiratory function. |
A particularly important consideration is the presence of pre-existing neurological deficits, such as numbness, paresthesia, or motor weakness. The clinician must meticulously assess and document these symptoms before performing any regional block. Establishing a clear neurological baseline is essential to mitigate medicolegal risk and ensure that any postoperative symptoms are not incorrectly attributed to the procedure itself. Having explored the indications and contraindications, we can now examine the anatomical foundation upon which a successful block is built.