Combined Axillary Block with Spinal Block Anaesthesia

Arsil Radiansyah, John Frans Sitepu, Luwih Bisono


Background:  Patients undergoing upper limb trauma surgery have reported various benefits of regional anesthesia over general anesthesia, including better perioperative analgesia, less opiate use, less postoperative nausea and vomiting (PONV), and a shorter post-anesthesia care period. ……………………………..
Case Illustration: We reported an evaluation of 72 years old, 165 cm height and 60 kg weight male patient who was planned for open reduction and internal fixation surgery for neglected left radius ulna close fracture and left neglected tibia fibula close fracture that he was beneath follow-up for hypertension (HT), and was using antihypertensive drugs. Preoperative risk of the patient was assessed as with American Society of Anesthesiologists (ASA) with score 3.General anesthesia would be unsafe due to geriatric issue, cardiovascular problem and delayed surgery term, we chosed to utilize combine axillary block with spinal block. we utilized USG guided infusion procedure in arrange to diminish local anesthetic dosage, and minimize error. During surgical procedure there is no hypotension, bradycardia or decreased oxygen saturation. Surgical anesthesia occurred in left hand within 20 minutes after drug delivery and 10 minutes in lower extremity. Surgery complications was not reported particularly related to vascular punction or adjacent anesthetic and nerve block applications. No complaint was detailed from the patient who was watched for 12 hours after the surgery.

Conclusion: Peripheral nerve block and neuraxial block, when utilized appropriately in combination, appear be able to supplant common anesthesia within the larger part of case.


axillary block; spinal block; combined anesthesia 

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1. Kaye AD, Allampalli V, Fisher P, et al. Supraclavicular vs. Infraclavicular brachial plexus nerve blocks: Clinical, pharmacological, and anatomical considerations. Anesthesiol Pain Med; 11. Epub ahead of print 2021. DOI: 10.5812/AAPM.120658.

2. Zadrazil M, Opfermann P, Marhofer P, et al. Brachial plexus block with ultrasound guidance for upper-limb trauma surgery in children: a retrospective cohort study of 565 cases. Br J Anaesth 2020; 125: 104–109.

3. Mangla C, Kamath HS, Yarmush J. Bilateral brachial plexus block using chloroprocaine for surgery of bilateral radial fractures [response to letter]. Local Reg Anesth 2019; 12: 125–126.

4. Wang ZX, Zhang DL, Liu XW, et al. Efficacy of ultrasound and nerve stimulation guidance in peripheral nerve block: A systematic review and meta-analysis. IUBMB Life 2017; 69: 720–734.

5. Alfred V, Srinivasan G, Zachariah M. Comparison of ultrasound with peripheral nerve stimulator guided technique for supraclavicular block in upper limb surgeries: A randomized controlled trial. Anesth Essays Res 2018; 12: 50.

6. Gadsden JC. The role of peripheral nerve stimulation in the era of ultrasound‐guided regional. Assoc Anaesth 2021; 76: 65–73.

7. Honnannavar K, Mudakanagoudar M. Comparison between conventional and ultrasound-guided supraclavicular brachial plexus block in upper limb surgeries. Anesth Essays Res 2017; 11: 467.

8. Ponde VC, Chavan DN, Desai AP, et al. Avoidance of deep anesthesia and artificial airways in 1000 neonates and infants using regional anesthesia: A retrospective observational analysis. J Anaesthesiol Clin Pharmacol 2020; 36: 386.

9. Teunkens A, Vermeulen K, Belmans A, et al. Patient satisfaction with intravenous regional anaesthesia or an axillary block for minor ambulatory hand surgery: A randomised controlled study. Eur J Anaesthesiol 2020; 37: 847–856.

10. Matsumura N, Inoue S, Iwagami H, et al. Comparison of Patient Satisfaction between Brachial Plexus Block (Axillary Approach) and General Anesthesia for Surgical Treatment of Distal Radius Fractures: A Historical Cohort Study. Open J Anesthesiol 2020; 10: 422–434.

11. Luftig J, Mantuani D, Herring AA, et al. Ultrasound-guided retroclavicular approach infraclavicular brachial plexus block for upper extremity emergency procedures. Am J Emerg Med 2017; 35: 773–777.

12. Hamilton GM, Ramlogan R, Lui A, et al. Peripheral Nerve Blocks for Ambulatory Shoulder Surgery: A Population-based Cohort Study of Outcomes and Resource Utilization. Anesthesiology 2019; 131: 1254–1263.

13. Kim BG, Yang C, Lee K, et al. Bilateral brachial plexus block in a patient with cervical spinal cord injury: A case report. Medicine (Baltimore) 2020; 99: e21126.

14. Tarıkçı Kılıç E, Akdemir MS. Comparison of Supraclavicular, Infraclavicular, and Axillary Approaches for Ultrasound-Guided Brachial Plexus Block for Upper Limb Surgeries: A Retrospective Analysis of 182 Blocks. Dubai Med J 2018; 1: 33–37.


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