Muscular twitches involving the anterior deltoid at a depth of 6 to 8 cm indicate the axillary nerve has been located.
The needle should be withdrawn 1 cm and walked superiorly in the vertical plane until free bone is contacted, or until deltoid twitch indicates the axillary nerve has been located.
The direction of local anaesthetic spread during axillary nerve block is dramatically illustrated with the use of radio-opaque dye (Figures 7a and 7b).
The author has performed the combined suprascapular and axillary nerve in 70 instances up to the time of submission of this report.
This report describes a new technique for local anaesthetic blockade of both the suprascapular nerve and the axillary nerve, which may provide effective relief of postoperative shoulder pain.
The low rates of postoperative morphine dose reported following the author's first 40 cases could be due to augmentation of the suprascapular nerve block by axillary nerve blockade providing analgesia closer in quality to an interscalene block.
Burkhead WZ, Scheinberg RR, Box G: Surgical anatomy of the axillary nerve.
Zhao X, Hung LK, Zhang GM, Lao J: Applied anatomy of the axillary nerve for selective neurotization of the deltoid muscle.
Duparc F, Bocquet G, Simonet J, Freger P: Anatomical basis of the variable aspects of injuries of the axillary nerve (excluding the terminal branches in the deltoid muscle).
Kontakis GM, Steriopoulos K, Damilakis J, Michalodimitrakis E: The position of the axillary nerve in the deltoid muscle: A cadaveric study.
McFarland EG, Caicedo JC, Kim TK, Banchasuek P: Prevention of axillary nerve injury in anterior shoulder reconstructions: Use of a subscapularis muscle-splitting technique and a review of the literature.
Loomer R, Graham B: Anatomy of the axillary nerve and its relation to inferior capsular shift.