Ultrasound Guided Axillary Block for Upper Limb Surgery, Rural Experience


Ultrasound-guided axillary block is a standard anesthetic technical for surgery of the lower part of the upper limbs including the arm, elbow, forearm, wrist and fingers. We carried out a prospective and descriptive study over 03 years on patients undergoing upper limb surgery under ultra sound guided axillary block, out in the surgery department of the CHDII saint croix Isoanala south Madagascar, rural area. The purpose of this study is to evaluate the efficiency of ultrasound-guided axillary blocks for upper limb surgery.

We included 67 patients with a mean age of 35.53±10.68 years with a predominantly male population. The majority of our patients were classified ASA I. The average installation time of the sensitivity block is 11.09 ± 3.86 minutes. The average block realization time is 8.62 ± 1.39 minutes. The average duration of the sensitivity block is 270.10 ± 57.32 minutes. The success rate is estimated at 88.05%. Complications were observed in 22.38% of cases (N=15), including 5 paresthesia, 3 vascular punctures, 4 infiltration pain and 3 tachycardia. Axillary block is an anesthesia technique that can be performed even in a rural hospital center. This technique can replace general anesthesia for some upper limb surgeries. The use of ultrasonography makes it easy to carry out and reduces the doses of anesthetics.

Axillary block is a standard anesthetic technique for surgery of the lower part of the upper limbs, arms, elbow, forearm, wrist and fingers. In recent years, in developed countries, loco regional anesthesia has continued to develop and is becoming the reference technique. Ultrasound-guided axillary block has recently been introduced in Madagascar. We carried out this study for several reasons, firstly, our center is located in an isolated place with very limited equipment to perform general anesthesia, therefore general anesthesia is reserved especially for major procedures such as peritonitis ; secondly, the cost of general anesthesia is largely high compared to that of loco regional anesthesia, yet the majority of our patients have a low standard of living, their financial means do not allow them to pay for the cost of surgery under general anesthesia; however, we have an ultrasound machine that allows us to perform echo-guided loco regional anesthesia.

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