Dr Stuart Myers

Managing Axillary Blocks

Managing Axillary Blocks   


Post – op care of Axillary Blocks:

Anaesthetic has been placed around the brachial plexus under ultrasound guidance by the anaesthetist.

The Block may last for 12 – 24 hours depending on the type of anaesthetic used.

When performing circulation checks obviously the patient will not be able to complain of pain or numbness to alert you that dressings or plasters are TOO tight.

It is vital therefore to pay extra attention to excessive swelling and the colour of the fingers.

Beware pressure on the ulnar nerve at the elbow. The patient will not complain of pain.

With drip stand slings have the arm resting on the bed – not on the sling. The sling is there to stop the arm from falling over - not to elevate it.

The patient has no control over the arm and so can hit themselves in the face with the plaster if not warned.

The biggest problem with these blocks is when they wear off.

The pain can be severe because they have no blood levels of analgesics.

This often happens in the middle of the night.

The solution to this problem is:

1. Give patients oral analgesia as they are going off to sleep even if the block has not worn off.  Eg Panadeine forte or Endone or Tramal as prescribed by the anaesthetist.

2. If the block has not worn off in the morning after surgery give them more analgesia.

3. As soon as the patient notes some tingling in the fingers suggesting the block is wearing off give strong analgesia immediately.

The blocks may wear off very quickly.

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