Leprosy
Mailing List – February 11th, 2010
Ref.: Axillary
blocks
From:
Wim Theuvenet, Apeldoorn, The Netherlands
Dear
Angelika,
Thank
you very much for your message dated LML Jan. 23rd, 2010.
Please allow for an addition to some other comments:
1.
All
problems arose in axillary blocks that were not succesfull! A
rare complication even in the hands of a skilled anaesthesiologist is
the creation of a big haematoma around
the axillary artery of which the resorption may affect all the 3
peripheral nerves. Final
recovery can take up to 12 months!
Perhaps your anaesthesiologist should receive a copy of
"Regional Block" written by D.C.Moore ?
2.
The tourniquet time should not be applied/ necessary longer than a
45-60 minutes, as the cuff can be removed immediately after the
tunnelling, and thus long before the final suturing of all
transferred slips.
3.
Did you check the pressure of the inflated cuff, this can be limited
to the max. systolic pressure plus
100 mm
Hg.? When using ketamine
for a failed block the titration rate is often increased only when
pain is noticed. This
pain may cause a temporary increase of the systolic blood
pressure which, when the cuff pressure is not corrected accordingly,
may cause venous blood congestion which is worse than ischaemia.
Hope
that your future patients will face less trouble!
With
warm personal regards,
Wim
Theuvenet, M.D., Ph.D.
Plastic
and Reconstructive Surgeon.
