ESRA Academy. Berrill A. Sep 8, 2016; 138427; 0274 Topic: Hand Surgery
Andrew Berrill
Andrew Berrill

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Background and Aims:

Loss of sensation to cold is a validated method to assess effectiveness of axillary block1.The aim of this study was to compare the effectiveness of a chlorhexidine soaked swab for assessment of axillary brachial plexus block.


Twenty-one patients receiving ultrasound guided axillary block were recruited. When the sensation to cold with a gauze swab soaked in standard 0.5% chlorhexidine was lost, the block was assessed with ethyl chloride spray, pin prick and a skin pinch in the distribution of radial nerve (anatomical snuff box) by two consultant anaesthetists.


All blocks performed in this study provided anaesthesia that was satisfactory for surgery.  Sensation was lost to chlorhexidine in all cases. However some sensations remained with other forms of testing. Table 1 shows the results.

Table 1: Assessment of block with ethyl chloride spray, skin pinch and pin prick (when the cold sensation to 0.5% chlorhexidine swab is lost)


All patients were transferred to theatre on loss of sensation to cold with 0.5 % chlorhexidine swab. Despite the fact that some patients reported sensations with other modes of testing, none required any supplementation intraoperatively from the surgeons. This may be due to psychological factors affecting the interpretation of sensations and may delay the start of surgery.  

Our work suggests that a chlorhexidine swab may be a simple and effective alternative to other modes of testing, such as ice (not readily available) and ethyl chloride spray (an atmospheric pollutant).

Ref. 1. Anesth Analg. 2006 Feb;102(2):598-604

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