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KMID : 0381219840160020129
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Journal of RIMSK
1984 Volume.16 No. 2 p.129 ~ p.133
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Changes in Axillary Sheath Pressure During Brachial Plexus Block by Axillary Route
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Abstract
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Large volume of local anesthetic solution used during brachial plexus block by axillary route may produce elevated pressures within the axillary sheath that lead to axillary artery compression and diminished blood flow.
We measured axillary sheath pressure as a function of injected volume in 20 patients scheduled for forearm surgery. One per cent lidocaine solution without epinephrine was injected into the axillary sheath in 10 ml increment until a cumulative volume of 50 ml was attained.
Axillary sheath elastance(?P/?V), where ?P equals change in axillary sheath pressure (mmHg) and ?V equals change in volume of local anesthetic solution(ml) was calculated. The results were as follows:
1) Mean axillary sheath pressure was 17.5±9.29 mmHg.
2) While the intrasheath pressure was increased in proportion to increment of local anesthetic solution in the successful cases, there was no apparent increase in the failed cases.
3) We found out that axillary sheath had elastance, that is, the elastance of the first 10 ml injection of local anesthetic solution was 1.45±0.82 mmHg/ml and it was gradually decreased following each 10 ml increment of anesthetic solution. But we did not find out the elastance in the failed cases.
4) Clinically vascular insufficiency resulting from increased axillary sheath pressure with large volume of local anesthetic solution seemed to be unlikely.
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