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The axillary approach to the brachial plexus nerve block was first described by Dr. Halstead et al. in 1884. Before the prevalence of ultrasound, this approach was useful for patients undergoing outpatient hand surgery due to the superficial location and low risk of complications such as pneumothorax. Its superficial location allows for easier identification of the individual nerve branches with a nerve stimulator or ultrasound techniques. Of note, contrary to its name, this block does not block the axillary nerve and should not be confused with the relatively newer axillary nerve block. This activity reviews the indications and methodology for performing an axillary block and highlights the role of the interprofessional team in the management of patients requiring regional anesthesia. Objectives: Explain how to perform an axillary block. Describe how to position a patient for an axillary block. Outline the indications for an axillary block. Review the importance of clear communication and coordination among the interprofessional team to enhance the care of patients requiring an axillary block. Access free multiple choice questions on this topic.

The axillary approach to the brachial plexus nerve block was first described by Dr. Halstead et al. in 1884. Before the prevalence of ultrasound, its superficial location and low risk of complications, such as pneumothorax, made it a useful block for outpatient hand surgery. Its superficial location allows for easier identification of the individual nerve branches with a nerve stimulator or ultrasound techniques. Of note, contrary to its name, this block does not block the axillary nerve and should not be confused with the relatively newer axillary nerve block.[1][2] For the remainder of this article, the discussion will only address the axillary approach to the brachial plexus.

Following complications are possible, but their incidence is low: Infection Bleeding or hematoma formation Nerve injuries, such as neuropraxia, axonotmesis, and neurotmesis Inadvertent intravascular injection Local anesthetic systemic toxicity

Peripheral nerve blocks are a team effort. The regionalist, as well as the nursing and support staff, are all essential in helping to maintain the highest standards of care. Hemodynamic monitors should always be applied, and nursing staff should make sure emergency drugs and equipment should be easily accessible to the clinician performing the procedure. As with any other regional technique, the risk of local anesthetic systemic toxicity is always present, so 20% lipid emulsion should be immediately available. Meticulous records of the procedure and administered medications should are requisite. The operating room nurse should work with the procedural clinician to coordinate the recording of the steps. Pharmacists should review the choice of medications and check for drug interactions and contraindications. Clear, organized, and succinct communication with other members of the patient's care team should be the norm. Once the procedure is completed, nurses will need to monitor vital signs and report to the clinician should there be any abnormalities. This interprofessional approach will result in the best outcomes. [Level V]