Axillary blocks

Leprosy Mailing List – February 11^th, 2010

Ref.: Axillary blocks

From: Wim Theuvenet, Apeldoorn, The Netherlands

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Dear Angelika,

Thank you very much for your message dated LML Jan. 23^rd, 2010. Please allow for an addition to some other comments:

1.

All problems arose in axillary blocks that were not succesfull! A rare complication even in the hands of a skilled anaesthesiologist is the creation of a big haematoma around the axillary artery of which the resorption may affect all the 3 peripheral nerves. Final recovery can take up to 12 months! Perhaps your anaesthesiologist should receive a copy of "Regional Block" written by D.C.Moore ?

2.
The tourniquet time should not be applied/ necessary longer than a 45-60 minutes, as the cuff can be removed immediately after the tunnelling, and thus long before the final suturing of all transferred slips.

3.
Did you check the pressure of the inflated cuff, this can be limited to the max. systolic pressure plus 100 mm Hg.? When using ketamine for a failed block the titration rate is often increased only when pain is noticed. This pain may cause a temporary increase of the systolic blood pressure which, when the cuff pressure is not corrected accordingly, may cause venous blood congestion which is worse than ischaemia.

Hope that your future patients will face less trouble!

With warm personal regards,

Wim Theuvenet, M.D., Ph.D.

Plastic and Reconstructive Surgeon.