• Trygve Kjelstrup, Per K Hol, Frédéric Courivaud, Hans-Jørgen Smith, Magne Røkkum, and Øivind Klaastad.
• From the Department of Anaesthesiology, Diakonhjemmet Hospital (TK), The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo (TK, PKH, FC), Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo (HJS), Department of Orthopaedics, Oslo University Hospital, Rikshospitalet, Oslo (MR), Department of Anaesthesiology, University Hospital of North Norway and Institute of Clinical Medicine, University of Tromsø, Tromsø (ØK) and Institute of Clinical Medicine, University of Oslo, Oslo, Norway (HJS, MR).
• Eur J Anaesthesiol. 2014 Nov 1; 31 (11): 611-9.

BackgroundAxillary plexus blocks are usually guided by ultrasound, but alternative methods may be used when ultrasound equipment is lacking. For a nonultrasound-guided axillary block, the need for three injections has been questioned.ObjectivesCould differences in block success between single, double and triple deposits methods be explained by differences in local anaesthetic distribution as observed by MRI?DesignA blinded and randomised controlled study.SettingConducted at Oslo University Hospital, Rikshospitalet, Norway from 2009 to 2011.PatientsForty-five ASA 1 to 2 patients scheduled for surgery were randomised to three equally sized groups. All patients completed the study.InterventionsPatients in the single-deposit group had an injection through a catheter parallel to the median nerve. In the double-deposit group the patients received a transarterial block. In the triple-deposit group the injections of the two other groups were combined. Upon completion of local anaesthetic injection the patients were scanned by MRI, before clinical block assessment. The distribution of local anaesthetic was scored by its closeness to terminal nerves and cords of the brachial plexus, as seen by MRI. The clinical effect was scored by the degree of sensory block in terminal nerve innervation areas.Main Outcome MeasuresSensory block effect and MRI distribution pattern.ResultsThe triple-deposit method had a higher success rate (100%) than the single-deposit method (67%) and the double-deposit method (67%) in blocking all cutaneous nerves distal to the elbow (P = 0.04). The patients in the triple-deposit group most often had the best MRI scores. For any nerve or cord, at least one of the single-deposit or double-deposit groups had a similarly high MRI score as the triple-deposit group.ConclusionDistal to the elbow, the triple-deposit method had the highest sensory block success rate. This could be explained to some extent by analysis of the magnetic resonance images.Trial RegistrationClinicalTrials.gov identifier: NCT01033006.

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