Axillary Brachial Plexus Block: A Simplified Approach

Valkyrie Blog Team
May 7
2 min read

Introduction

The Axillary Brachial Plexus Block (ABPB) is a widely used regional anesthesia technique for upper limb surgeries. This article compares the Single Injection, Multi-Injection, and Simplified Multi-Injection as shown in Admir Hadzic’s Axillary Brachial Plexus Block video tutorial. Dr. Hadzic’s video tutorial breaks down the procedure into clear, actionable steps, ensuring safe and effective execution.

An overview of three techniques.

Technique	Pros	Cons	Injection Details
Single Injection	- Faster procedure - Less discomfort for patient - Requires fewer needle passes	- Less reliable nerve coverage - Higher risk of incomplete block	Single injection into the brachial plexus sheath, usually above or behind the axillary artery with 20–30 mL of anesthetic.
Multi-Injection	- Improves nerve coverage - Can lead to better anesthesia quality - Lower risk of missed nerves	- More time-consuming - Increased patient discomfort due to multiple needle passes	Separate injections targeting individual nerves: Radial nerve: 8–10 mL (posterior to the artery) Musculocutaneous & Ulnar nerves: 8–10 mL (above the artery) Musculocutaneous nerve: 4–6 mL (between biceps & coracobrachialis).
Dr. Hadzic’s Technique	- Systematic approach targeting key nerves - Balanced efficiency & success rate - Ensures musculocutaneous nerve coverage - Incorporates ultrasound guidance for precision	- Requires anatomical knowledge & ultrasound experience - Slightly longer than single injection	Strategic injections optimizing nerve blockade: Radial nerve: 8 mL (posterior to artery) Musculocutaneous nerve: 4 mL (between muscles) Median & Ulnar nerves: 8 mL (above artery).

Let's take a closer look at Hadzic's simplified technique tutorial.

Key Anatomical Considerations

The axillary artery serves as a landmark for identifying the brachial plexus sheath.
The median, ulnar, and radial nerves are enclosed within the sheath.
The musculocutaneous nerve lies outside the sheath, requiring a separate injection.

Step-by-Step Technique

Identify the axillary artery using palpation or ultrasound guidance.
Insert the needle behind the artery and inject 8 ml of local anesthetic to block the radial nerve.
Withdraw the needle slightly and inject 4 ml between the biceps and coracobrachialis muscles to target the musculocutaneous nerve.
Reposition the needle above the artery and inject 8 ml into the sheath to block the median and ulnar nerves.
Confirm adequate anesthesia by assessing sensory and motor responses

Photo courtesy of NYSORA: This image demonstrates the ideal distribution pattern of local anesthetic. In this particular disposition of nerves, a single needle pass superficially to the artery allows for two injections: one for the median (MN) and a second one between the ulnar (UN) and radial (RN). The musculocutaneous (MCN) requires a separate injection.

Clinical Pearls

Ultrasound guidance enhances precision and minimizes complications.
Incremental injections improve nerve coverage and reduce the risk of intravascular injection.
Patient positioning (arm abducted) facilitates needle access and visualization.

Conclusion

Dr. Hadzic’s tutorial provides a structured approach to mastering the axillary brachial plexus block. His emphasis on anatomical landmarks and systematic injections ensures a high success rate while minimizing risks. For a visual demonstration, you can watch the full tutorial here.

Commitment to Teaching and Learning Through Simulation

At Valkyrie, we believe in advancing medical education through simulation. Our dedication to refining regional anesthesia techniques ensures that clinicians gain hands-on experience with the highest level of precision.