Pseudoaneurysm of the axillary artery with median-nerve deficit after axillary block anesthesia. A case report.

A sixty-five-year-old man had a twenty-six-year history of rheumatoid arthritis. An axillary block of the right brachial plexus was performed for an arthroplasty of a metacarpophalangeal joint on the right hand, with interposition of a spacer of silicone rubber. The patient’s medical history included hypercholesterolemia, arteriosclerotic peripheral vascular disease, arteriosclerotic coronary artery disease, congestive heart failure, hypertension, peptic ulcer, and bronchospasm. He had been taking digoxin, furosemide, nifedipine, potassium chloride, cimetidine, naproxen, sulfasalazine, albuterol, and ipratropium bromide. An endarterectomy of the right carotid artery had been performed, and a resection arthroplasty of the metacarpophalangeal joints had been done on the left hand, with interposition of silicone-rubber spacers. Laboratory studies done preoperatively showed that the prothrombin time, activated partial thromboplastin time, and platelet count were all normal. Bleeding time was not determined. The anesthesiologist used a 25-gauge needle, 1 .9 centimeters (0.75 inch), and an anesthetic mixture of 1 per cent lidocaine (thirty milliliters), 0.5 per cent lidocaine (fifteen milliliters), and sodium bicarbonate solution (five milliliters). The axillary sheath was located and was entered, and the anesthetic solution was injected at the sites associated with paresthesias in the distribution of the median and ulnar nerves. The artery was then located within the sheath by aspiration of blood, and the solution was injected posterior and anterior to the artery. The technique included constant aspiration with the exploratory needle, except when drugs were injected. The procedure was uneventful. On the first postoperative day, the patient could wiggle the thumb and all of the fingers, and sensation in the right upper extremity was intact. Two days postoperatively, the patient complained of numbness in the hand. The symptoms were relieved when the dressing was loosened, and sensation was intact. The patient was discharged from the hospital on the following day. He returned to the emergency room the next day because of pain.