Comparison between Perivascular and Perineural Ultrasound-guided Axillary Nerve Block for Forearm Surgeries: A Randomized Controlled Study

Introduction: Brachial plexus block has evolved in procedures for upper limb surgeries when William Halsted performed it for the first time in 1884. Brachial plexus is formed by anterior primary rami of C5 to C8 and T1 nerves which emerge from intervertebral foramina. Objective: The objective of this study was to compare ultrasound-guided perivascular (PV) and perineural (PN) axillary nerve block. Materials and Methods: This prospective randomized comparative study was done in 50 patients posted for forearm surgery. This study was done to compare two techniques axillary block under ultrasound guidance. They were divided into two groups, namely, PN and PV group. In PN group, the median, ulnar, and radial nerves are blocked separately. In PV group, the local anesthetic is injected dorsal to the axillary artery. Intraoperatively, the imaging time, needling time, performance time, number of needle passes, vascular puncture, and onset of sensory and motor blockade were observed and recorded. Results: According to this study, both PN and PV techniques have similar success rate. However, the performance time and number of needle passes were less in PV technique. Hence, the procedure-related pain was less in PV group. Conclusion: The PV technique provides a simple alternative to axillary block under ultrasound guidance.