Abstract

Axillary brachial plexus block is a widely used regional anesthesia technique for upper extremity surgery. Ultrasound guidance and neurostimulation are commonly employed methods; however, their comparative effects on block performance and perioperative outcomes remain controversial. This prospective randomized study included 80 patients aged 18–75 years scheduled for upper extremity surgery under axillary brachial plexus block. Patients were randomly assigned to either the ultrasound-guided group (Group U, n = 40) or the neurostimulation-guided group (Group N, n = 40). Demographic characteristics, our primary outcomes such as block application time, time to motor block onset, and our secondary outcomes such as time to first postoperative analgesic requirement, block success rate, and block-related complications were recorded and analysed. Demographic characteristics, comorbidities, and block success rates were comparable between the groups. Block application time was significantly shorter in group U than in Group N (4.3 ± 0.7 vs. 8.7 ± 0.9 minutes, p < 0.001). The median time to motor block onset was also shorter in group U (10 [7–13] minutes) compared with group N (18 [14–23] minutes, p < 0.001). The time to first postoperative analgesic requirement was longer in group U than in Group N (11.5 [9–14] vs. 10 [1–13] hours, p < 0.001). The overall complication rate was 7.5% (n = 3) in group U and 12.5% (n = 5) in group N. Ultrasound-guided axillary brachial plexus block provides shorter block application and onset times with a lower complication rate compared to neurostimulation-guided techniques. In appropriately equipped centers, ultrasound guidance may be considered a more effective and potentially safer approach for axillary blocks in upper extremity surgery.

Key words: Upper extremity surgery; Axillary brachial plexus block; Ultrasound guidance; Nerve stimulation; Regional anesthesia