Axillary Block through Its Anterior Fold- A New Approach

Back ground: Absence of abduction or presence of restricted abduction movement of shoulder or presence of infection or space occupying mass in axilla creates difficulties or offers impossibilities to expose axilla for brachial plexus block at the same level. Aims: To introduce axillary block in the presence of axillary infection, mass and restricted movement of the shoulder through anterior fold of the axilla. Methods: Nerve stimulator needle was inserted perpendicularly along the medial side of humerus in supine position of the patient to elicit the distal response of individual muscle and injected 40 ml of local anesthetic solution by multi-injection technique at multiple sites (mid-arm, and wrist block). Results: Brachial plexus block at the level of the axilla through its anterior fold offered satisfactory area of analgesia with motor block for the surgeries on the elbow, forearm, wrist, and hand. Multi-injection technique with the help of nerve stimulator needle contributed 100% success rate. Conclusion: It is an appropriate alternative form of brachial plexus block at the level of the axilla in presence of restricted abduction movement of the shoulder, infection and mass in the axilla.