Review
Ultrasound and nerve stimulation-guided axillary block
Bloqueo axilar guiado por ultrasonido y neuroestimulador
Luz María Lopera-Velásqueza,
, Carlos Restrepo-Garcésb,c
Corresponding author
lulopera@hotmail.com
Corresponding author at: Department of Anaesthesia and Perioperative Medicine, University of Western Ontario, 339 Windermere Road, London, Ontario, Canada.
Corresponding author at: Department of Anaesthesia and Perioperative Medicine, University of Western Ontario, 339 Windermere Road, London, Ontario, Canada.
Read
17206
Timeswas read the article
1127
Total PDF
16079
Total HTML
Share statistics
array:25 [ "pii" => "S2256208715000851" "issn" => "22562087" "doi" => "10.1016/j.rcae.2015.11.004" "estado" => "S300" "fechaPublicacion" => "2016-01-01" "aid" => "246" "copyright" => "Sociedad Colombiana de Anestesiología y Reanimación" "copyrightAnyo" => "2015" "documento" => "article" "crossmark" => 1 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "ssu" "cita" => "Rev Colomb Anestesiol. 2016;44:30-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4171 "formatos" => array:3 [ "EPUB" => 102 "HTML" => 3778 "PDF" => 291 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0120334715001100" "issn" => "01203347" "doi" => "10.1016/j.rca.2015.10.002" "estado" => "S300" "fechaPublicacion" => "2016-01-01" "aid" => "246" "copyright" => "Sociedad Colombiana de Anestesiología y Reanimación" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "ssu" "cita" => "Rev Colomb Anestesiol. 2016;44:30-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7738 "formatos" => array:3 [ "EPUB" => 104 "HTML" => 6830 "PDF" => 804 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Revisión</span>" "titulo" => "Bloqueo axilar guiado por ultrasonido y neuroestimulador" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "30" "paginaFinal" => "35" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Ultrasound and nerve-stimulator guided axillary block" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Fuente: autores." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 801 "Ancho" => 1615 "Tamanyo" => 150674 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Dermatomas de la parte anterior del miembro superior.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luz María Lopera-Velásquez, Carlos Restrepo-Garcés" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Luz María" "apellidos" => "Lopera-Velásquez" ] 1 => array:2 [ "nombre" => "Carlos" "apellidos" => "Restrepo-Garcés" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2256208715000851" "doi" => "10.1016/j.rcae.2015.11.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208715000851?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334715001100?idApp=UINPBA00004N" "url" => "/01203347/0000004400000001/v1_201601280029/S0120334715001100/v1_201601280029/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2256208715000899" "issn" => "22562087" "doi" => "10.1016/j.rcae.2015.10.002" "estado" => "S300" "fechaPublicacion" => "2016-01-01" "aid" => "250" "documento" => "article" "crossmark" => 1 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Rev Colomb Anestesiol. 2016;44:36-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1134 "formatos" => array:3 [ "EPUB" => 92 "HTML" => 708 "PDF" => 334 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Essay</span>" "titulo" => "Healthcare professional competencies in legal doctrine" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "36" "paginaFinal" => "39" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Las competencias del profesional sanitario en la doctrina jurídica" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José M<span class="elsevierStyleSup">a</span> Maestre" "autores" => array:1 [ 0 => array:2 [ "nombre" => "José M<span class="elsevierStyleSup">a</span>" "apellidos" => "Maestre" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0120334715001148" "doi" => "10.1016/j.rca.2015.10.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334715001148?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208715000899?idApp=UINPBA00004N" "url" => "/22562087/0000004400000001/v1_201601280036/S2256208715000899/v1_201601280036/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2256208715000802" "issn" => "22562087" "doi" => "10.1016/j.rcae.2015.09.005" "estado" => "S300" "fechaPublicacion" => "2016-01-01" "aid" => "241" "documento" => "article" "crossmark" => 1 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "ssu" "cita" => "Rev Colomb Anestesiol. 2016;44:23-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1435 "formatos" => array:3 [ "EPUB" => 98 "HTML" => 1041 "PDF" => 296 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "The use of cerebral monitoring for intraoperative awareness" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "23" "paginaFinal" => "29" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uso de monitorizacion cerebral para el despertar intraoperatorio" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: author." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 446 "Ancho" => 2471 "Tamanyo" => 45970 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Memory outline.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Karina Castellon-Larios, Byron R. Rosero, María Claudia Niño-de Mejía, Sergio D. Bergese" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Karina" "apellidos" => "Castellon-Larios" ] 1 => array:2 [ "nombre" => "Byron R." "apellidos" => "Rosero" ] 2 => array:2 [ "nombre" => "María Claudia" "apellidos" => "Niño-de Mejía" ] 3 => array:2 [ "nombre" => "Sergio D." "apellidos" => "Bergese" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0120334715001057" "doi" => "10.1016/j.rca.2015.09.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334715001057?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208715000802?idApp=UINPBA00004N" "url" => "/22562087/0000004400000001/v1_201601280036/S2256208715000802/v1_201601280036/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Ultrasound and nerve stimulation-guided axillary block" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "30" "paginaFinal" => "35" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Luz María Lopera-Velásquez, Carlos Restrepo-Garcés" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Luz María" "apellidos" => "Lopera-Velásquez" "email" => array:1 [ 0 => "lulopera@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Carlos" "apellidos" => "Restrepo-Garcés" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Anaesthesia and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Pain Relief Clinic, Surgery and Imaging Department, Hospital Pablo Tobón Uribe, Medellín, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Pain Relief Unit & Anaesthesia Department, Clínica Las Américas, Medellín, Colombia" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author at</span>: Department of Anaesthesia and Perioperative Medicine, University of Western Ontario, 339 Windermere Road, London, Ontario, Canada." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bloqueo axilar guiado por ultrasonido y neuroestimulador" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "<span class="elsevierStyleItalic">Source</span>: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 963 "Ancho" => 1658 "Tamanyo" => 173537 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Dermatomes of the posterior aspect of the upper limb.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The axillary block is a regional anaesthesia technique, involving blockade of the brachial plexus at the axillary level. It is widely used as an anaesthetic and analgesic technique in upper limb surgery, specifically for hand, wrist and forearm procedures. In the axillary block, the terminal branches of the brachial plexus are blocked. The use of nerve stimulation and ultrasound has increased the rate of success with this block<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">1</span></a> and has reduced the incidence of complications. Unlike the inter-scalene and supra and infraclavicular blocks, the risk of injury to the stellate ganglion, pneumothorax or phrenic nerve palsy is practically non-existent with this block because of the site where the puncture is performed.<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">2,3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">A search was conducted in the Cochrane, Medline/Pubmed, OVID and EMBASE databases using the words axillary block, ultrasound, nerve stimulator, regional anaesthesia. Included in the search were meta-analyses, systematic reviews, clinical trials and non-systematic reviews, and articles in English, Spanish and French.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">History</span><p id="par0015" class="elsevierStylePara elsevierViewall">The first percutaneous axillary block was described by Hirschel in 1911.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">4</span></a> In 1958, Burnham described how the axillary neurovascular bundle was enveloped by a fascia that could be “filled” with local anaesthetic.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">5</span></a> In 1961, De Jong referred to the axillary space as a pyramid of 42<span class="elsevierStyleHsp" style=""></span>ml in volume, and described that the nerves and blood vessels were surrounded individually by septae.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">6</span></a> In 1979, Eriksson and Skarby used a tourniquet distal to the axillary injection site and, in 1984, Thompson and Rorie identified the brachial plexus septae in the axillary space as preventing the homogenous spread of the anaesthetic.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">7</span></a> More recently, cadaver studies using nuclear magnetic resonance have concluded that the terminal branches are lined by connective tissue and fascial sheaths that prevent the anaesthetic from flowing homogenously after a single injection and covering the entire plexus.<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">8,9</span></a> The nerve stimulator was introduced in the 1990s, and ultrasound has been introduced in recent years<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">10</span></a>; their use has increased the rate of success with the axillary block. The use of nerve stimulation and ultrasound has also reduced the number of complications because of the smaller volume of local anaesthetic required to achieve blockade,<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">11–13</span></a> although there are reports in which the use of ultrasound does not reduce the occurrence of complications when compared to the nerve stimulator.<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">14</span></a> Complications associated with the axillary block include toxicity from the local anaesthetics<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">15</span></a> and neurological and vascular injury,<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">16,17</span></a> although there is a paucity of reports in the literature on these occurrences, supporting the theory that this block provides a high safety margin. Obesity increases the risk of vascular puncture and failure rates with this type of block.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Anatomy</span><p id="par0020" class="elsevierStylePara elsevierViewall">The brachial plexus arises from the ventral branches of C5 to C8. At the level of the scalene muscles, these branches regroup to form the superior, middle and inferior trunks, and when they leave the inter-scalene space, they form anterior and posterior divisions at the supraclavicular level. The divisions regroup again at an infraclavicular level to form the three lateral, posterior and medial cords which finally give rise to the five terminal branches at the axillary level: radial, axillary, musculocutaneous, median and ulnar nerves (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">19</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The radial nerve arises from the posterior cord. It runs together with the radial artery along its posterior aspect and breaks away from the neurovascular bundle at the axillary level in order to continue along the spiral humeral groove. It provides sensation to the posterior and lateral aspects of the arm and forearm down to the wrist, the lateral aspect of the dorsum down to the hand, the dorsal surface of the first three digits and half of the fourth digit. It provides motor innervation to the triceps and brachioradialis muscles and to the extensors of the posterior compartment of the forearm.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The axillary nerve arises from the posterior cord at the level of the coracoid process, forming an angle towards the deltoid muscle, which it innervates (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The median nerve traverses most of the time superior to the axillary artery, while the ulnar and axillary nerves are found inferior to the axillary artery. The median nerve does not have cutaneous or motor branches in the arm, but in the forearm it provides motor innervation to the anterior compartment, except for the flexor carpi ulnaris and half of the flexor digitorum profundus. In the hand, it innervates the thenar eminence and the first two lumbrical muscles. It provides sensation to the lateral half of the hand and the dorsum of the first three digits, and half of the fourth finger down to the nail bed.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The ulnar nerve arises from the medial cord and it does not provide branches to the arm. It provides motor innervation to the flexor carpi ulnaris and the medial half of the flexor digitorum profundus. In the hand, it innervates all the small muscles except for the thenar eminence and the first two lumbricals. It provides sensitive innervation to the middle third of the palm, the dorsum of the fifth finger, and the medial aspect of the fourth finger.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The musculocutaneous nerve arises from the lateral cord, perforates the coracobrachialis muscle and leaves the neurovascular sheath usually at the level of the lateral edge of the pectoralis major. It may be found outside the coracobrachialis muscle and joining the median nerve in 1 out of 5 individuals.<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">20</span></a> It provides motor innervation to the coracobrachialis, biceps and brachialis muscles. At the elbow, it becomes a purely sensory nerve, innervating the anterior portion of the forearm down to the wrist (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Technique</span><p id="par0050" class="elsevierStylePara elsevierViewall">The axillary block is used in hand, wrist and forearm surgery. It is not as effective as other brachial plexus blocks in elbow surgery.<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">21</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The axillary block may be performed using a nerve stimulator, ultrasound or a combination of the two. With the use of the nerve stimulator, the failure rate is 5–30%, while the two techniques combined increase the success rate by up to 97%.<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">22</span></a> As for the time required for performing the block, no significant difference has been found with the two techniques; ultrasound has allowed the use of a smaller local anaesthetic volume, although this affects the duration of the effect. One of the advantages of ultrasound is the ability to visualize the nerves – making blockade easier in patients with anatomic variants<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">23</span></a> – and the spread of the local anaesthetic as it is injected.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">24</span></a> Complications associated with the axillary block appear to be less when ultrasound is used.<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">25</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The patient is positioned in supine decubitus, with the arm in 90° of abduction and the forearm in flexion (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). Asepsis must be performed up to the distal portion of the arm. A high frequency linear probe is placed on the transverse axis, over the axillary fold. The neurovascular bundle is localized 1–2<span class="elsevierStyleHsp" style=""></span>cm underneath the skin.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The axillary artery must be localized first. It provides a spherical, pulsatile hypoechoic image and it is not readily compressible. It is found over the conjoined tendon, formed by the junction of the latissimus dorsi and teres major tendons. It is important to identify the axillary vein, because it also provides a spherical and hypoechoic image, although it is not pulsating and is readily compressible. The median, ulnar and radial nerves are arranged around the artery. They appear as spherical or oval-shaped, hyperechogenic, hypoechogenic or beehive-like structures. Their position around the artery is not constant. The position of the radial and the median nerves in relation to the artery is usually constant.<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">26</span></a> The radial nerve is located between 4 and 6 o’clock in 83% of cases, the median nerve is found between 9 and 12 o’clock in 88% of cases, and the ulnar nerve is between 12 and 3 o’clock in 85% of cases.<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">27</span></a> The musculocutaneous nerve is usually separated laterally from the artery, between the short head of the biceps and the coracobrachialis muscle (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Once the structures have been identified under ultrasound, the skin is infiltrated with local anaesthetic and then, using a 50<span class="elsevierStyleHsp" style=""></span>mm 22G nerve stimulator needle on an in-plane approach, the nerves are localized with the nerve stimulator (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). There is no significant difference in terms of success using the echogenic or non-echogenic needle in this type of block.<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">28</span></a> It is recommended to use a 0.5–1.0<span class="elsevierStyleHsp" style=""></span>mA current in order to reduce the risk of dysfunction or nerve injury. Stimulation with a current of 0.3–0.5<span class="elsevierStyleHsp" style=""></span>mA increases the success of the block and shortens the onset time, but increases the risk of nerve injury.<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">29</span></a> When muscle stimulation is obtained with a 0.2<span class="elsevierStyleHsp" style=""></span>mA current or less, an intraneural injection must be suspected to be likely.<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">30</span></a> Once the corresponding muscle contraction is obtained, syringe aspiration is done in order to rule out intravascular injection, and then the local anaesthetic is injected, always under ultrasound guidance in order to visualize the deposition of the anaesthetic around the nerve.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Three ways of injecting the local anaesthetic at the axillary level have been described: a single injection, dual injection, and multiple injections to deliver the full volume of the anaesthetic. When a single injection is used, the anaesthetic is delivered under the axillary artery. In the dual injection, part of the dose is delivered under the artery and the other part is delivered around the musculocutaneous nerve.<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">31</span></a> The most effective technique with less associated complications but the most time consuming is the multiple injections.<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">22</span></a> The time to onset of the axillary block varies depending on the injection technique. In the study conducted by Lopez-Morales et al. comparing the axillary block with the inflaclavicular block, time to onset was significantly longer for the axillary block, at a mean of 10.2<span class="elsevierStyleHsp" style=""></span>min.<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">32</span></a> Blockade rate for the axillary, intercostobrachial and medial cutaneous nerves of the arm is lower through the axillary approach.<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">33</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The choice of the local anaesthetic depends on the duration of the block and the availability in the Anaesthesia service. Reducing the local anaesthetic concentration and increasing the volume prolongs the duration of the block.<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">34,35</span></a> Levobupivacaine and ropivacaine have been used in concentrations of 0.375–0.75% and 0.25–0.5%, respectively. Compared to levobupivacaine, ropivacaine has a faster onset of action (9<span class="elsevierStyleHsp" style=""></span>min vs. 12<span class="elsevierStyleHsp" style=""></span>min) but blockade duration is shorter (9.2<span class="elsevierStyleHsp" style=""></span>h vs. 11.3<span class="elsevierStyleHsp" style=""></span>h).<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">36</span></a> The total volume used ranges between 30 and 40<span class="elsevierStyleHsp" style=""></span>ml when delivered in a single injection, and between 5 and 8<span class="elsevierStyleHsp" style=""></span>ml when each nerve is anaesthetized individually. González et al. found that the MAC-90 of 1.5% lidocaine with epinephrine 5mcg/ml is 5.5<span class="elsevierStyleHsp" style=""></span>ml and 23.5<span class="elsevierStyleHsp" style=""></span>ml in the dual injection technique.<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">37</span></a> The minimum effective volume (MEV90) of 0.5% bupivacaine is 1.56<span class="elsevierStyleHsp" style=""></span>ml per nerve.<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">38</span></a> The use of other additives to prolong the block, like using dexamethasone with the local anaesthetic, has shown to be an effective way to increase motor and sensory blockade.<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">39,40</span></a> The use of clonidine as adjunct to the local anaesthetic has not been shown to increase block duration,<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">41</span></a> different from dexmedetomidine which does appear to prolong axillary block duration.<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">42,43</span></a> Magnesium sulphate has also been used as additive in axillary blocks, but has not been shown to improve block duration or efficacy.<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">44</span></a> Other adjuncts such as ketamine and tramadol have also been used, and some studies have shown evidence that they prolong the action of the axillary block.<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">45</span></a> There is recent evidence about the effect of hyaluronidase in shortening the time to onset of the axillary block in upper limb surgery.<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">46</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Continuous infusion of the local anaesthetic using catheters is not well documented in the literature.<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">47,48</span></a> The axillary region is prone to catheter displacement and does not allow adequate fixation. The continuous infusion technique for the local anaesthetic has been used, but it is the surgeon who places the catheter under direct vision.<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">49</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">It is recommended to add the intercostobrachial nerve block to the axillary block in order to increase tolerance of the tourniquet during the surgical procedure.<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">50</span></a> This nerve is the cutaneous branch of the second intercostal nerve and provides sensory innervation to the upper portion of the medial and posterior aspects of the arm.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusion</span><p id="par0095" class="elsevierStylePara elsevierViewall">The brachial plexus block at the axillary level is an anaesthetic and analgesic technique used with a high degree of success in upper limb surgery, creating little difficulty for the procedure. The use of nerve stimulation and ultrasound has increased the rate of effectiveness of this block and reduced the rate of complications.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Funding</span><p id="par0100" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare having no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres599828" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec614172" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres599829" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Métodos y Materiales" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec614171" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "History" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Anatomy" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Technique" ] ] ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-07-17" "fechaAceptado" => "2015-10-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec614172" "palabras" => array:4 [ 0 => "Ultrasonography" 1 => "Ultrasonics" 2 => "Anesthesia, Conduction" 3 => "Nerve block, Analgesia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec614171" "palabras" => array:5 [ 0 => "Ultrasonografía" 1 => "Ultrasonido" 2 => "Anestesia de conducción" 3 => "Bloqueo nervioso" 4 => "Analgesia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The axillary block of the brachial plexus is widely used as an anaesthesia and analgesia technique in upper limb surgery, specifically for hand, wrist and forearm procedures. The use of nerve stimulation and ultrasound guidance has increased the rate of success with this block.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This article presents a non-systematic review of the most recent literature on axillary block of the brachial plexus using ultrasound and peripheral nerve stimulation.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A search for a non-systematic review was conducted in the Cochrane, Pubmed/Medline, Embase and OVID databases.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The axillary block of the brachial plexus is an anaesthetic and analgesic technique for upper limb surgery that has a high percentage of success, with a low degree of difficulty for the procedure.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El bloqueo axilar del plexo braquial es un bloqueo anestésico ampliamente utilizado como técnica anestésica y analgésica en cirugía de miembro superior, específicamente para mano, muñeca y antebrazo. El uso de neuroestimulador y ultrasonido ha aumentado la tasa de éxito de éste bloqueo.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El presente artículo hace una revisión no sistemática de la literatura más reciente relacionada con el bloqueo axilar del plexo braquial utilizando ultrasonido y estimulación de nervio periférico.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Métodos y Materiales</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se hizo una búsqueda en las bases de datos de Cochrane, Pubmed/Medline, Embase y OVID para la realización de una revisión no sistemática.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El bloqueo del plexo braquial a nivel axilar es una técnica anestésica y analgésica para cirugía de miembro superior con alto porcentaje de éxito y bajo grado de dificultad en cuanto a realización del procedimiento.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Métodos y Materiales" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lopera-Velásquez LM, Restrepo-Garcés C. Bloqueo axilar guiado por ultrasonido y neuroestimulador. Rev Colomb Anestesiol. 2016;44:30–35.</p>" ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "<span class="elsevierStyleItalic">Source</span>: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1115 "Ancho" => 1658 "Tamanyo" => 168472 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Illustration of the terminal branches of the brachial plexus at the axillary level.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "<span class="elsevierStyleItalic">Source</span>: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 822 "Ancho" => 1662 "Tamanyo" => 161207 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Dermatomes of the anterior aspect of the upper limb.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "<span class="elsevierStyleItalic">Source</span>: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 963 "Ancho" => 1658 "Tamanyo" => 173537 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Dermatomes of the posterior aspect of the upper limb.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "<span class="elsevierStyleItalic">Source</span>: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 559 "Ancho" => 995 "Tamanyo" => 110539 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Axillary block of the brachial plexus at the level of the axilla using a linear transducer and a nerve stimulation needle.</p>" ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "<span class="elsevierStyleItalic">Source</span>: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1018 "Ancho" => 1658 "Tamanyo" => 94492 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Ultrasound image of the brachial plexus at the axillary level. UN<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>ulnar nerve, RN<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>radial nerve, MN<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>median nerve, MCN<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>musculocutaneous nerve, AA<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>axillary artery, CT<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>conjoined tendon.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "<span class="elsevierStyleItalic">Source</span>: Authors." "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Radial nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Arm or wrist extension \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Median nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Forearm pronation, thumb flexion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ulnar nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Flexion of the fifth finger \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Musculocutaneous nerve \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Arm flexion \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab981256.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Motor responses with nerve stimulation of each nerve.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:50 [ 0 => array:3 [ "identificador" => "bib0255" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What benefits does ultrasound-guided axillary block for brachial plexus anaesthesia offer over the conventional blind approach in hand surgery?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B. Strub" 1 => "J. Sonderegger" 2 => "A. Von Campe" 3 => "J.J. Osterwalder" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Hand Surg Eur" "fecha" => "2011" "volumen" => "36" "paginaInicial" => "778" "paginaFinal" => "786" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0260" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Axillary brachial plexus block" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Satapathy" 1 => "D.M. Coventry" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Anesth Res Pr" "fecha" => "2011" "volumen" => "2011" "paginaInicial" => "1" "paginaFinal" => "5" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0265" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bloqueo axilar del plexo braquial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Monkowski" 1 => "C.S. Gay Larese" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Arg Anest" "fecha" => "2004" "volumen" => "62" "paginaInicial" => "440" "paginaFinal" => "444" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0270" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Axillary plexus block: paresthetic or perivascular" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Selander" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "1987" "volumen" => "66" "paginaInicial" => "726" "paginaFinal" => "728" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3592271" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0275" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Simple regional nerve block for surgery of the hand and forearm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.J. Burnham" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Med Assoc" "fecha" => "1959" "volumen" => "169" "paginaInicial" => "941" "paginaFinal" => "943" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13630710" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0280" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Axillary block of the brachial plexus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.H. De Jong" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "1961" "volumen" => "22" "paginaInicial" => "215" "paginaFinal" => "225" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13720553" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0285" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Functional anatomy of the brachial plexus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Thompson" 1 => "D.K. Rorie" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "1983" "volumen" => "59" "paginaInicial" => "117" "paginaFinal" => "122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6869868" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0290" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The axillary sheath and single-injection axillary block" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Ay" 1 => "M. Akinci" 2 => "M. Sayin" 3 => "U. Bektas" 4 => "I. Tekdemir" 5 => "A. Elhan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ca.20270" "Revista" => array:6 [ "tituloSerie" => "Clin Anat" "fecha" => "2007" "volumen" => "20" "paginaInicial" => "57" "paginaFinal" => "63" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16372345" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0295" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High-resolution MRI demonstrates detailed anatomy of the axillary brachial plexus. A pilot study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Kjelstrup" 1 => "F. Courivaud" 2 => "Ø. Klaastad" 3 => "H. Breivik" 4 => "P.K. Hol" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1399-6576.2012.02703.x" "Revista" => array:6 [ "tituloSerie" => "Acta Anaesthesiol Scand" "fecha" => "2012" "volumen" => "56" "paginaInicial" => "914" "paginaFinal" => "919" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22571443" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0300" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transition from nerve stimulator to sonographically guided axillary brachial anesthesia in hand surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Luyet" 1 => "M. Constantinescu" 2 => "M. Waltenspul" 3 => "M. Luginbuhl" 4 => "E. Vogelin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7863/ultra.32.5.779" "Revista" => array:6 [ "tituloSerie" => "J Ultrasound Med" "fecha" => "2013" "volumen" => "32" "paginaInicial" => "779" "paginaFinal" => "786" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23620319" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0305" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound guidance improves success rate of axillary brachial plexus block" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "V.W. Chan" 1 => "A. Perlas" 2 => "C.J. McCartney" 3 => "R. Brull" 4 => "D. Xu" 5 => "S. Abbas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF03022637" "Revista" => array:6 [ "tituloSerie" => "Can J Anesth" "fecha" => "2007" "volumen" => "54" "paginaInicial" => "176" "paginaFinal" => "182" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17331928" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0310" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brachial plexus blocks for upper extremity orthopaedic surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B.G. Bruce" 1 => "A. Green" 2 => "T.A. Blaine" 3 => "L.V. Wesner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5435/JAAOS-20-01-038" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Orthop Surg" "fecha" => "2012" "volumen" => "20" "paginaInicial" => "38" "paginaFinal" => "47" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22207517" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0315" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound-guided bilateral brachial plexus blockade with propofol-ketamine sedation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Toju" 1 => "T. Hakozaki" 2 => "M. Akatsu" 3 => "T. Isosu" 4 => "M. Murakawa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00540-011-1238-9" "Revista" => array:6 [ "tituloSerie" => "J Anesth" "fecha" => "2011" "volumen" => "25" "paginaInicial" => "927" "paginaFinal" => "929" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21964729" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0320" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outpatient regional anesthesia for upper extremity surgery update (2005 to present) distal to shoulder" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.M. Maga" 1 => "L. Cooper" 2 => "R.E. Gebhard" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int Anesth Clin" "fecha" => "2012" "volumen" => "50" "paginaInicial" => "47" "paginaFinal" => "55" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0325" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications of single-injection ultrasound-guided infraclavicular block: a cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Lecours" 1 => "S. Lévesque" 2 => "N. Dion" 3 => "M.-J. Nadeau" 4 => "A. Dionne" 5 => "A.F. Turgeon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12630-012-9825-2" "Revista" => array:6 [ "tituloSerie" => "Can J Anesth" "fecha" => "2013" "volumen" => "60" "paginaInicial" => "244" "paginaFinal" => "252" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23212697" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0330" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Axillary arteriovenous fistula after axillary plexus block" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.-J. Gong" 1 => "H.-J. Yuan" 2 => "Z.-H. Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00540-013-1577-9" "Revista" => array:6 [ "tituloSerie" => "J Anesth" "fecha" => "2013" "volumen" => "27" "paginaInicial" => "604" "paginaFinal" => "606" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23440566" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0335" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of local anesthetic systemic toxicity and postoperative neurologic symptoms associated with 12,668 ultrasound-guided nerve blocks" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.D. Sites" 1 => "A.H. Taenzer" 2 => "M.D. Herrick" 3 => "C. Gilloon" 4 => "J. Antonakakis" 5 => "J. Richins" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/AAP.0b013e31825cb3d6" "Revista" => array:6 [ "tituloSerie" => "Reg Anesth Pain Med" "fecha" => "2012" "volumen" => "37" "paginaInicial" => "478" "paginaFinal" => "482" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22705953" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0340" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple injection axillary brachial plexus block: influence of obesity on failure rate and incidence of acute complications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.-L. Hanouz" 1 => "W. Grandin" 2 => "A. Lesage" 3 => "G. Oriot" 4 => "D. Bonnieux" 5 => "J.-L. Gérard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0b013e3181dde023" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2010" "volumen" => "111" "paginaInicial" => "230" "paginaFinal" => "233" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20418535" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0345" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brachial plexus anesthesia: a review of the relevant anatomy. Complications, and anatomical variations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Mian" 1 => "I. Chaudhry" 2 => "R. Huang" 3 => "E. Rizk" 4 => "R.S. Tubbs" 5 => "M. Loukas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ca.22254" "Revista" => array:6 [ "tituloSerie" => "Clin Anat" "fecha" => "2014" "volumen" => "27" "paginaInicial" => "210" "paginaFinal" => "221" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23959836" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0350" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is the musculocutaneous nerve really in the coracobrachialis muscle when performing an axillary block? An ultrasound study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Remerand" 1 => "J. Laulan" 2 => "C. Couvret" 3 => "M. Palud" 4 => "A. Baud" 5 => "S. Velut" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0b013e3181dc25c8" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2010" "volumen" => "110" "paginaInicial" => "1729" "paginaFinal" => "1734" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20435937" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0355" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of axillary nerve block in elbow arthroscopic surgery: a randomized trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Wada" 1 => "M. Yamauchi" 2 => "G. Oki" 3 => "T. Sonoda" 4 => "M. Yamakage" 5 => "T. Yamashita" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Shoulder Elb Surg" "fecha" => "2014" "volumen" => "23" "paginaInicial" => "291" "paginaFinal" => "296" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0360" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Single, double or multiple-injection techniques for non-ultrasound guided axillary brachial plexus block in adults undergoing surgery of the lower arm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Chin" 1 => "H. Alakkad" 2 => "J. Cubillos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2013" "paginaInicial" => "CD003842" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0365" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bloc axillaire, balance bénéfices/risques: quel est le bénéfice de lábord sous échographie?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Cuvillon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.annfar.2012.06.016" "Revista" => array:6 [ "tituloSerie" => "Ann Fr Anesth Reanim" "fecha" => "2012" "volumen" => "31" "paginaInicial" => "e193" "paginaFinal" => "e197" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22841353" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0370" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recognition of local anesthetic maldistribution in axillary brachial plexus block guided by ultrasound and nerve stimulation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.C. Veneziano" 1 => "V.K. Rao" 2 => "S.L. Orebaugh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jclinane.2011.06.009" "Revista" => array:6 [ "tituloSerie" => "J Clin Anesth" "fecha" => "2012" "volumen" => "24" "paginaInicial" => "141" "paginaFinal" => "144" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22414707" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0375" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comparative study between ultrasound and neurostimulation guided axillary brachial plexus block" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.B. Da Conceição" 1 => "P.E. Helayel" 2 => "G.R. de Oliveira Filho" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Bras Anestesiol" "fecha" => "2009" "volumen" => "59" "paginaInicial" => "585" "paginaFinal" => "591" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19784514" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0380" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bloqueo axilar ecoguiado: variaciones anatómicas de la disposición de los 4 nervios terminales del plexo braquial en relación con la arteria humeral" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.G. Silva" 1 => "X. Sala-Blanch" 2 => "R. Marin" 3 => "X. Espinoza" 4 => "A. Arauz" 5 => "C. Morros" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.redar.2013.07.009" "Revista" => array:7 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2014" "volumen" => "61" "paginaInicial" => "15" "paginaFinal" => "20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24161518" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673610614936" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0385" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound anatomy of the brachial plexus nerves in the neurovascular bundle at the axilla in patients undergoing upper-extremity block anesthesia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Ustuner" 1 => "A. Yılmaz" 2 => "E. Özgencil" 3 => "F. Okten" 4 => "S.C. Turhan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Skelet Radiol" "fecha" => "2013" "volumen" => "42" "paginaInicial" => "707" "paginaFinal" => "713" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0390" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The importance of needle echogenity in ultrasound guided axillary brachial plexus block: a randomized controlled clinical study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Duger" 1 => "A.C. Isbir" 2 => "K. Kaygusuz" 3 => "I.O. Kol" 4 => "S. Gursoy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7150/ijms.6598" "Revista" => array:6 [ "tituloSerie" => "Int J Med Sci" "fecha" => "2013" "volumen" => "10" "paginaInicial" => "1108" "paginaFinal" => "1112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23869186" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0395" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High- versus low-stimulation current threshold for axillary plexus blocks: a prospective randomized triple-blinded noninferiority trial in 205 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Vassiliou" 1 => "H.-H. Müller" 2 => "A. Ellert" 3 => "P. Wallot" 4 => "K.-M. Kwee" 5 => "M. Beyerle" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0b013e31826fffef" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2013" "volumen" => "116" "paginaInicial" => "247" "paginaFinal" => "254" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23223121" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0400" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound-guided regional anesthesia for upper limb surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.-J. Nadeau" 1 => "S. Lévesque" 2 => "N. Dion" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12630-012-9874-6" "Revista" => array:6 [ "tituloSerie" => "Can J Anesth" "fecha" => "2013" "volumen" => "60" "paginaInicial" => "304" "paginaFinal" => "320" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23377861" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0405" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Double-injection perivascular ultrasound-guided axillary brachial plexus block according to needle positioning: 12 versus 6 o’clock position of the axillary artery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Cho" 1 => "Y.J. Kim" 2 => "J.-H. Kim" 3 => "H.-J. Baik" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Korean J Anesth" "fecha" => "2014" "volumen" => "66" "paginaInicial" => "112" "paginaFinal" => "119" ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0410" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bloqueo axilar ecoguiado frente a bloqueo infraclavicular ecoguiado para la cirugía de miembro superior" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Lopez-Morales" 1 => "A. Moreno-Martin" 2 => "J. Leal del Ojo" 3 => "F. Rodriguez-Huertas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.redar.2013.02.012" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2013" "volumen" => "60" "paginaInicial" => "313" "paginaFinal" => "319" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23684374" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0415" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The extent of blockade following axillary and infraclavicular approaches of brachial plexus block in uremic patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Sariguney" 1 => "A. Mahli" 2 => "D. Coskun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4021/jocmr723w" "Revista" => array:6 [ "tituloSerie" => "J Clin Med Res" "fecha" => "2011" "volumen" => "4" "paginaInicial" => "26" "paginaFinal" => "32" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22383924" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0420" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of the efficacy of different concentrations and volumes of levobupivacaine in axillary brachial plexus blockade" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Ozcan" 1 => "S. Izdes" 2 => "L. Ozturk" 3 => "O. Kanbak" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Minerva Anestesiol" "fecha" => "2014" "volumen" => "80" "paginaInicial" => "330" "paginaFinal" => "336" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24107831" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0425" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of local anesthetic volume (15 vs 40<span class="elsevierStyleHsp" style=""></span>mL) on the duration of ultrasound-guided single shot axillary brachial plexus block: a prospective randomized, observer-blinded trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.P.W. Schoenmakers" 1 => "J.T. Wegener" 2 => "R. Stienstra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/AAP.0b013e3182405df9" "Revista" => array:6 [ "tituloSerie" => "Reg Anesth Pain Med" "fecha" => "2012" "volumen" => "37" "paginaInicial" => "242" "paginaFinal" => "247" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22266898" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0430" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparative study of ropivacaine 0.5% and levobupivacaine 0.33% in axillary brachial plexus block" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. González-Suárez" 1 => "M. Pacheco" 2 => "J. Roigé" 3 => "M.M. Puig" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/AAP.0b013e3181ae729b" "Revista" => array:6 [ "tituloSerie" => "Reg Anesth Pain Med" "fecha" => "2009" "volumen" => "34" "paginaInicial" => "414" "paginaFinal" => "419" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19920417" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0435" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Minimum effective volume of lidocaine for double-injection ultrasound-guided axillary block" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.P. González" 1 => "F. Bernucci" 2 => "K. Pham" 3 => "J.A. Correa" 4 => "R.J. Finlayson" 5 => "D.Q.H. Tran" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/AAP.0b013e3182707176" "Revista" => array:6 [ "tituloSerie" => "Reg Anesth Pain Med" "fecha" => "2013" "volumen" => "38" "paginaInicial" => "16" "paginaFinal" => "20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23146999" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0440" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Determination of the minimum effective volume of 0.5% bupivacaine for ultrasound-guided axillary brachial plexus block" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L.H.C. Ferraro" 1 => "A. Takeda" 2 => "L.F. dos Reis Falcão" 3 => "A.H. Rezende" 4 => "E.J. Sadatsune" 5 => "M.A. Tardelli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Bras Anestesiol" "fecha" => "2014" "volumen" => "64" "paginaInicial" => "49" "paginaFinal" => "53" ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0445" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of postoperative analgesic effect of dexamethasone and fentanyl added to lidocaine through axillary block in forearm fracture" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Yaghoobi" 1 => "M. Seddighi" 2 => "Z. Yazdi" 3 => "R. Ghafouri" 4 => "M.B. Khezri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Pain Res Treat" "fecha" => "2013" "volumen" => "2013" "paginaInicial" => "1" "paginaFinal" => "6" ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0450" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound-guided peripheral nerve blockade of the upper extremity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Z.J. Koscielniak-Nielsen" 1 => "J.B. Dahl" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Curr Opin Anesth" "fecha" => "2012" "volumen" => "25" "paginaInicial" => "253" "paginaFinal" => "259" ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0455" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clonidine does not improve quality of ropivacaine axillary brachial plexus block in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Trifa" 1 => "S. Ben Khalifa" 2 => "A. Jendoubi" 3 => "N. Zribi" 4 => "T. Regaya" 5 => "T. Engelhardt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1460-9592.2012.03809.x" "Revista" => array:6 [ "tituloSerie" => "Paediatr Anaesth" "fecha" => "2012" "volumen" => "22" "paginaInicial" => "425" "paginaFinal" => "429" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22309507" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0460" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of adding dexmedetomidine to levobupivacaine in axillary brachial plexus block" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Kaygusuz" 1 => "I.O. Kol" 2 => "C. Duger" 3 => "S. Gursoy" 4 => "H. Ozturk" 5 => "U. Kayacan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.curtheres.2012.03.001" "Revista" => array:6 [ "tituloSerie" => "Curr Ther Res Clin Exp" "fecha" => "2012" "volumen" => "73" "paginaInicial" => "103" "paginaFinal" => "111" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24648597" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0465" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perineural administration of dexmedetomidine in combination with ropivacaine prolongs axillary brachial plexus block" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Zhang" 1 => "C. Wang" 2 => "J. Shi" 3 => "B. Sun" 4 => "S. Liu" 5 => "P. Li" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Clin Exp Med" "fecha" => "2014" "volumen" => "7" "paginaInicial" => "680" "paginaFinal" => "685" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24753763" "web" => "Medline" ] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0470" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of postoperative brachial plexus block using MgSO<span class="elsevierStyleInf">4</span> on the postoperative pain after upper extremity surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I.G. Choi" 1 => "Y.S. Choi" 2 => "Y.H. Kim" 3 => "J.H. Min" 4 => "Y.K. Chae" 5 => "Y.K. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3344/kjp.2011.24.3.158" "Revista" => array:6 [ "tituloSerie" => "Korean J Pain" "fecha" => "2011" "volumen" => "24" "paginaInicial" => "158" "paginaFinal" => "163" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21935495" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0475" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Does the addition of tramadol and ketamine to ropivacaine prolong the axillary brachial plexus block?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.C. Senel" 1 => "O. Ukinc" 2 => "A. Timurkaynak" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Biomed Res Int" "fecha" => "2014" "paginaInicial" => "686287" ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0480" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of hyaluronidase as an adjuvant to ropivacaine to reduce axillary brachial plexus block onset time: a prospective, randomised controlled study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.U. Koh" 1 => "H.G. Min" 2 => "H.S. Park" 3 => "M.H. Karm" 4 => "K.K. Lee" 5 => "H.S. Yang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/anae.12879" "Revista" => array:6 [ "tituloSerie" => "Anaesthesia" "fecha" => "2015" "volumen" => "70" "paginaInicial" => "282" "paginaFinal" => "289" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25347936" "web" => "Medline" ] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0485" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Combined axillary block with “selective” injection of nerves and the axillary catheter: comparison of bupivacaine 0.25% or levobupivacaine 0.25%" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Al" 1 => "L. Pirbudak" 2 => "N. Tahtaci" 3 => "S. Kul" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Middle East J Anesth" "fecha" => "2012" "volumen" => "21" "paginaInicial" => "705" "paginaFinal" => "712" ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0490" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-stimulation needle with external indwelling cannula for brachial plexus block and pain management in 62 patients undergoing upper-limb surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B. Yu" 1 => "X. Zhang" 2 => "P. Sun" 3 => "S. Xie" 4 => "Q. Pang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7150/ijms.5007" "Revista" => array:6 [ "tituloSerie" => "Int J Med Sci" "fecha" => "2012" "volumen" => "9" "paginaInicial" => "766" "paginaFinal" => "771" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23136539" "web" => "Medline" ] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0495" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bilateral brachial plexus home going catheters after digital amputation for patient with upper extremity digital gangrene" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.A. Abd-Elsayed" 1 => "J. Seif" 2 => "M. Guirguis" 3 => "S. Zaky" 4 => "L. Mounir-Soliman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4021/jocmr645w" "Revista" => array:6 [ "tituloSerie" => "J Clin Med Res" "fecha" => "2011" "volumen" => "3" "paginaInicial" => "325" "paginaFinal" => "327" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22393345" "web" => "Medline" ] ] ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0500" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of 3 ultrasound-guided brachial plexus block approaches for cubital tunnel release surgery in 120 ambulatory patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Roussel" 1 => "S. Thirkannad" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AANA J" "fecha" => "2014" "volumen" => "82" "paginaInicial" => "121" "paginaFinal" => "126" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24902454" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22562087/0000004400000001/v1_201601280036/S2256208715000851/v1_201601280036/en/main.assets" "Apartado" => array:4 [ "identificador" => "34050" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Review articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22562087/0000004400000001/v1_201601280036/S2256208715000851/v1_201601280036/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208715000851?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 36 | 1 | 37 |
| 2024 October | 230 | 8 | 238 |
| 2024 September | 259 | 3 | 262 |
| 2024 August | 214 | 3 | 217 |
| 2024 July | 256 | 4 | 260 |
| 2024 June | 170 | 5 | 175 |
| 2024 May | 186 | 13 | 199 |
| 2024 April | 165 | 7 | 172 |
| 2024 March | 218 | 15 | 233 |
| 2024 February | 388 | 10 | 398 |
| 2024 January | 326 | 6 | 332 |
| 2023 December | 306 | 31 | 337 |
| 2023 November | 411 | 22 | 433 |
| 2023 October | 415 | 20 | 435 |
| 2023 September | 283 | 10 | 293 |
| 2023 August | 228 | 9 | 237 |
| 2023 July | 202 | 12 | 214 |
| 2023 June | 230 | 10 | 240 |
| 2023 May | 313 | 12 | 325 |
| 2023 April | 343 | 18 | 361 |
| 2023 March | 265 | 16 | 281 |
| 2023 February | 256 | 5 | 261 |
| 2023 January | 228 | 17 | 245 |
| 2022 December | 161 | 20 | 181 |
| 2022 November | 198 | 13 | 211 |
| 2022 October | 178 | 13 | 191 |
| 2022 September | 221 | 10 | 231 |
| 2022 August | 265 | 16 | 281 |
| 2022 July | 205 | 24 | 229 |
| 2022 June | 169 | 23 | 192 |
| 2022 May | 209 | 18 | 227 |
| 2022 April | 200 | 12 | 212 |
| 2022 March | 201 | 23 | 224 |
| 2022 February | 169 | 54 | 223 |
| 2022 January | 350 | 48 | 398 |
| 2021 December | 230 | 72 | 302 |
| 2021 November | 225 | 13 | 238 |
| 2021 October | 256 | 18 | 274 |
| 2021 September | 188 | 15 | 203 |
| 2021 August | 171 | 13 | 184 |
| 2021 July | 160 | 20 | 180 |
| 2021 June | 140 | 10 | 150 |
| 2021 May | 187 | 9 | 196 |
| 2021 April | 405 | 30 | 435 |
| 2021 March | 308 | 8 | 316 |
| 2021 February | 160 | 12 | 172 |
| 2021 January | 197 | 14 | 211 |
| 2020 December | 228 | 7 | 235 |
| 2020 November | 244 | 4 | 248 |
| 2020 October | 157 | 5 | 162 |
| 2020 September | 191 | 18 | 209 |
| 2020 August | 74 | 12 | 86 |
| 2020 July | 75 | 11 | 86 |
| 2020 June | 57 | 1 | 58 |
| 2020 May | 60 | 6 | 66 |
| 2020 April | 45 | 5 | 50 |
| 2020 March | 61 | 1 | 62 |
| 2020 February | 52 | 5 | 57 |
| 2020 January | 43 | 4 | 47 |
| 2019 December | 51 | 9 | 60 |
| 2019 November | 37 | 4 | 41 |
| 2019 October | 41 | 6 | 47 |
| 2019 September | 40 | 3 | 43 |
| 2019 August | 21 | 1 | 22 |
| 2019 July | 47 | 8 | 55 |
| 2019 June | 17 | 8 | 25 |
| 2019 May | 9 | 9 | 18 |
| 2019 March | 1 | 0 | 1 |
| 2018 December | 1 | 0 | 1 |
| 2018 November | 3 | 0 | 3 |
| 2018 September | 8 | 0 | 8 |
| 2018 July | 3 | 0 | 3 |
| 2018 June | 61 | 0 | 61 |
| 2018 May | 200 | 7 | 207 |
| 2018 April | 159 | 13 | 172 |
| 2018 March | 142 | 9 | 151 |
| 2018 February | 107 | 6 | 113 |
| 2018 January | 103 | 9 | 112 |
| 2017 December | 107 | 7 | 114 |
| 2017 November | 90 | 5 | 95 |
| 2017 October | 125 | 10 | 135 |
| 2017 September | 82 | 8 | 90 |
| 2017 August | 103 | 9 | 112 |
| 2017 July | 125 | 5 | 130 |
| 2017 June | 126 | 7 | 133 |
| 2017 May | 143 | 13 | 156 |
| 2017 April | 156 | 11 | 167 |
| 2017 March | 165 | 9 | 174 |
| 2017 February | 300 | 6 | 306 |
| 2017 January | 165 | 7 | 172 |
| 2016 December | 92 | 10 | 102 |
| 2016 November | 149 | 7 | 156 |
| 2016 October | 189 | 10 | 199 |
| 2016 September | 238 | 5 | 243 |
| 2016 August | 204 | 10 | 214 |
| 2016 July | 80 | 8 | 88 |
| 2016 June | 3 | 0 | 3 |
| 2016 May | 3 | 0 | 3 |
| 2016 April | 1 | 22 | 23 |
| 2016 March | 10 | 0 | 10 |
| 2016 February | 4 | 22 | 26 |
Show all