Nerve Puncture and Apparent Intraneural Injection during Ultrasound-guided Axillary Block Does Not Invariably Result in Neurologic Injury

Background Nerve puncture by the block needle and intraneural injection of local anesthetic are thought to be major risk factors leading to neurologic injury after peripheral nerve blocks. In this study, the author sought to determine the needle-nerve relation and location of the injectate during ultrasound-guided axillary plexus block. Methods Using ultrasound-guided axillary plexus block (10-MHz linear transducer, SonoSite, Bothel, WA; 22-gauge B-bevel needle, Becton Dickinson, Franklin Parks, NJ), the incidence of apparent nerve puncture and intraneural injection of local anesthetic was prospectively studied in 26 patients. To determine the onset, success rate, and any residual neurologic deficit, qualitative sensory and quantitative motor testing were performed before and 5 and 20 min after block placement. At a follow-up 6 months after the blocks, the patients were examined for any neurologic deficit. Results Twenty-two of 26 patients had nerve puncture of at least one nerve, and 21 of 26 patients had intraneural injection of at least one nerve. In the entire cohort, 72 of a total of 104 nerves had intraneural injection. Sensory and motor testing before and 6 months after the nerve injections were unchanged. Conclusions Under the conditions of this study, puncturing of the peripheral nerves and apparent intraneural injection during axillary plexus block did not lead to a neurologic injury.