>I am sure there was a paper on this in the JAEM recently.
>Cathy Makay et al I think.
>Axilliary approach Brachial Plexus block is my preferred approach.
________________________________________
>Andrew Hobart FRCS FFAEM
>Birmingham


You're right it was in JAEM. Abstract follows. Don't know why it did not 
come up last  night, but was a quick search and we know medline is imperfect 
(as am I!!!)


Authors
     Mackay CA. Bowden DF.
Institution
     Accident and Emergency Department, Manor
     Hospital, Walsall.
Title
     Axillary brachial plexus
     block--an underused technique in the
     accident and emergency department.
Source
     Journal of Accident &
     Emergency Medicine. 14(4):226-9, 1997 Jul.
Abstract
     OBJECTIVE: To compare axillary brachial plexus block and Bier's block 
as methods of providing upper limb
     anaesthesia. METHODS: Axillary brachial plexus or Bier's blocks were 
performed on all patients requiring upper
     limb anaesthesia in a three month period. For Bier's block, a single 
cuff tourniquet and 3 mg/kg 0.5% prilocaine were
     used. For axillary plexus block, 40 ml 1% lignocaine with adrenaline 
(1:200,000) were used, given by perivascular or
     transarterial technique. Prospective analysis was made of time to 
complete limb anaesthesia, type of procedure
     performed, and duration of limb anaesthesia. Patient perception of 
analgesia and satisfaction with the method of
     anaesthesia was assessed using a 10 point visual analogue scale. 
RESULTS: 75 patients underwent procedures
     requiring upper limb anaesthesia; 39 received axillary plexus block and 
36 Bier's block. 72% of Bier's blocks and
     77% of axillary plexus provided complete anaesthesia without the need 
for supplemental analgesia. The median time to
     onset of anaesthesia was 10 min for Bier's block and 32.5 min for 
axillary block (P < 0.001). The median duration of
     anaesthesia was 15 min for Bier's block and 240 min for axillary block 
(P < 0.001). Mean scores for analgesia were
     9.7 for axillary blocks and 8.8 for Bier's block (P < 0.001). 87% of 
the axillary block group were completely
     satisfied with the method of anaesthesia, compared with 56% of the 
Bier's block group. CONCLUSIONS: Brachial
     plexus blocks are an alternative form of providing upper limb 
anaesthesia in the accident and emergency department.
     They are relatively simple to perform, well tolerated by patients, and 
have the advantage of providing prolonged
     analgesia without the need for additional medication.

>From: Andrew G Hobart <[log in to unmask]>
>Reply-To: [log in to unmask]
>To: [log in to unmask]
>Subject: Re: Biers Blocks - evidence
>Date: Fri, 25 Feb 2000 23:08:08 +0000
>
>Simon Carley wrote:
>
> > >Axillary nerve block, Simon - with 23 Ch butterfly and lignocaine or
> > >prilocaine - also frees up everyone as it only takes 3 minutes to do 
>then
> > >the patient can sit and 'cook' for 40 minutes while you do something 
>else.
>
>And while the patient gets their X-Ray!
>(If you have not made the diagnosis clinically do they really need a
>manipulation?)
>
> >
> > The only reference I have found regarding this (in the form of a trial) 
>was
> > an uncontrolled trial of interscalene block - which I think is a variant 
>of
> > an axillary block (says so in the paper anyway)
>
>I am sure there was a paper on this in the JAEM recently.
>Cathy Makay et al I think.
>
>Axilliary approach Brachial Plexus block is my preferred approach.
>
>--
>Andrew
>_______________________________________________________
>Andrew Hobart FRCS FFAEM
>Birmingham
>
>
>

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