Complications associated with 27 031 ultrasound-guided axillary brachial plexus blocks A web-based survey of 36 French centres

BACKGROUND Ultrasound guidance improves the efficacy of peripheral nerve blocks, reducing performance time and local anaesthetic doses. It should also reduce the risk of systemic toxicity of local anaesthetic and nerve injuries. OBJECTIVE The primary objective of this prospective study was to estimate the incidence of immediate complications related to ultrasound-guided axillary brachial plexus blocks in a multicentre observational cohort. DESIGN Prospective multicentre observational study. SETTING Thirty-six French centres participated in the study between 2009 and 2012. PATIENTS A total of 27 031 axillary brachial plexus blocks were recorded. INTERVENTIONS The study objective, the incidence of immediate complications related to ultrasound-guided axillary brachial plexus blocks (intravascular injection of local anaesthetic and neurological deficit at hospital discharge), was based on data collected by anaesthesiologists through a web-based case report form. MAIN OUTCOME MEASURE Incidence of immediate complications related to ultrasound-guided axillary brachial plexus blocks. RESULTS Of 27 031 blocks performed, the incidence of systemic toxicity of local anaesthetic was very low at 1.5 per 10 000, and the overall incidence of postoperative neurological symptoms was 0.37 per 10 000. CONCLUSION We have reported a large series of ultrasound- guided axillary brachial plexus blocks in a multicentre study. Our results confirm the low incidence of local anaesthetic systemic toxicity and postoperative neurological complications as previously described.