• Emmanuel Guntz, Pierre Herman, Alain Delbos, and Maurice Sosnowski.
• Department of Anesthesiology, Université Libre de Bruxelles, Hôpital Universitaire Saint-Pierre, Brussels, Belgium. eguntz@ulb.ac.be
• Can J Anaesth. 2004 Apr 1;51(4):354-7.

PurposeThe brachial plexus block through the humeral canal as described by Dupré is indicated in hand and forearm surgery. This block requires a multi-stimulation technique that emphasizes the necessity of a rigorous and safe technique. Nerve injury associated with regional anesthesia can entail significant morbidity for patients. Thus, we investigated the brachial block sequence in terms of unintended nerve stimulation as a surrogate of potential nerve injury.MethodsSixty patients were randomly allocated in two groups of 30. In Group I the radial nerve was blocked before the ulnar nerve. In Group II the ulnar nerve was blocked before the radial nerve. During the radial nerve approach we recorded, if present, an ulnar nerve response. During the ulnar nerve approach we recorded, if present, a radial nerve response.ResultsIn Group I while looking for the radial nerve, in 50% of the cases, an ulnar motor response was recorded. In Group II while looking for the ulnar nerve, a radial motor response was recorded in 10% of the cases.ConclusionOur results indicate that the radial nerve should be blocked before the ulnar nerve when performing a brachial plexus block at the humeral canal.

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