Abstract:

Objective　To compare the clinical effect of axillary brachial plexus block performed by using three methods of nerve localization: variable posture and angle two-point method, the traditional one point method and peripheral nerve stimulation method.　Methods　Seventy-five emergency patients (ASAⅠ-Ⅱ) undergoing the forearm and hand surgery were selected and randomly divided into three groups (n=25):the variable posture and angle two-point method group (VTP) and the traditional one point method group (TOP) and peripheral nerve stimulator group (PNS) . Axillary brachial plexus block was performed with 45 ml of 0.375% ropivacaine in three groups. Success was defined as a sensory block of 5 nerves (median nerve, ulnar nerve, radial nerve, musculocutaneous nerve, medial brachial cutaneous nerve) with territories distal to the elbow 20 minutes after performing the block. The block success rate, onset time of analgesia, tourniquet tolerance and occurrence of complication were compared in three groups.   Results　The success rate of group VTP and PNS was higher than that of group TOP(96.0%,100% vs72.0%,P<0.01).The success rate of blocking of the radial and the musculocutaneous nerves in group VTP and PNS was obviously higher than that in group TOP( P<0.05).Onset time (T2) of group VTP and PNS was shorter than that of group TOP. Time to achieve readiness for surgery (T3) was shorter in group VTP than that in group TOP and PNS (P<0.05); Performance time(T1) of  group PNS was longer than that of group TOP and PNS.　Conclusions　 The technique of VTP is a good block method to make up for the shortcomings of the traditional one point method .Its advantage is a better block the radial and the musculocutaneous nerves and reduction of patients' discomfort caused by tourniquet. It can provide for hands and forearms operation a fast, simple, effective and relatively affordable anesthesia.　

Key words: Nerve block, Brachial plexus, Axilla, Variable posture and angle two-point method, The traditional one point method, Peripheral nerve stimulator