Comparison of three different volumes of mepivacaine in axillary plexus block using multiple nerve stimulation

Abstract

Background. The multiple injection technique for axillary block, in which the four distal nerves of the plexus are located by a nerve stimulator and separately injected, has been shown to provide a high success rate and a short onset time. This randomized double-blind study was conducted to compare the effectiveness of three different volumes of mepivacaine 10 mg ml-1 in patients undergoing elective distal upper limb surgery under axillary brachial plexus block with the four-nerve approach. The number of complete sensory blocks was the primary efficacy variable. Methods. A total of 114 adult patients were randomly allocated to receive 36 (n=38), 28 (n=38), and 20 ml (n=38) of mepivacaine 10 mg ml-1. In each group, volumes were equally distributed in the four nerve territories. In all patients, performance time, latency time, block characteristics, need of supplementary blocks, tourniquet tolerance, duration of analgesia, and complications were recorded. Results. Complete sensory block was obtained in 97% of patients receiving a volume of 36 ml, 97% of those receiving 28 ml, and 94% of those receiving 20 ml. One patient in the group of 28 ml and five patients in the group of 20 ml experienced pain on inflation of the tourniquet. Two months after surgery, no case of postoperative neurological dysfunction was observed. Conclusions. The three volumes (38, 28, and 20 ml) of mepivacaine 10 mg ml-1 ensured a similar and high percentage of complete sensory blocks in axillary brachial plexus anaesthesia with nerve stimulation involving the location of four motor responses.