The axillary block is a regional anesthetic technique used in conjunction with sedation or a light general anesthesia for surgeries of the elbow, forearm, wrist and hand. It is a safe and effective block that provides both safe and excellent surgical anesthesia and post-operative pain control.
During a preoperative phone interview the procedure as well as its risks and benefits will be discussed with you in detail. On arrival to the ASC prep area you will be asked to sign a consent for the procedure. You will then be attached to the usual monitors: a blood pressure cuff, a light sensor to measure your blood oxygen level will be attached to your finger, and EKG leads will be placed on your chest. You will receive some sedation through your intravenous prior to placement of the block, which both relaxes you and will likely cause you to have little or no recollection of the block placement.
Next, the anesthesiologist will cleanse your upper chest, axilla (armpit) and upper arm region on the operative side with an antiseptic solution. He or she will use both anatomical landmarks and an ultrasound machine to find the desired location for the axillary nerve block near the collarbone/shoulder region.
Once the best location is found, the anesthesiologist will numb the skin with some local anesthetic. Next he or she will slowly insert a needle as thin as a paperclip through the skin. Your anesthesiologist will utilize ultrasound to guide the needle to the proper location near the nerves. In addition to the ultrasound, occasionally, a process called nerve stimulation will be used to assist in verifying the location of the nerves to your arm/hand and optimizing needle placement. If nerve stimulation is used, a very small amount of electrical current will be put through the needle and you will feel the sensation of involuntary twitches or movements in your arm and hand. Don't try to stop these movements because they tell us if we are in the right location with the needle. When the location and/or response is optimal the anesthesiologist will inject the long acting Novocain like medicine in multiple small doses which will numb your arm and hand. This procedure takes only a few minutes to perform.
The block takes approximately 15-20 minutes to work. You will notice your arm and hand becoming gradually more weak and numb. Once in the operating room, you will once again be attached to the usual monitors and positioned by the surgeon. You will receive relatively deep levels of sedation or a light general anesthetic because it allows for better blood pressure control, less bleeding, and ultimately more patient comfort.
After the surgery and transport to the recovery room, the sedation or general anesthesia will begin to wear off. You may notice a few things. First you will have little or no pain and secondly you won't be able to move or feel your arm and hand.
The numbness and weakness from the block should last from 6-18 hours. As it begins to wear off you should start the pain medicine that was prescribed by the surgeon.