Free Anesthesiology Assistant Sample Questions

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First Free Anesthesiology Assistant Question

Which of the following is NOT a common complication of an axillary block?

A. Hematoma

B. Intravascular injection

C. Pneumothorax

D. Postoperative neuropathy

E. Systemic toxicity

Answer and Explanations

Pneumothorax is NOT a common complication of an axillary brachial plexus block.  This is a known complication of a supraclavicular block (SCB) where it occurs up to 6% of the time.

Cross-sectional anatomy of the right axillary nerve block.  The median, ulnar, and radial nerves are bundled with the axillary artery within the axillary sheath.  Puncture of the axillary artery or vein may cause hematoma formation.  Simultaneous nerve injury from needle trauma may also occur owing to the close proximity of the proximity of structures within axillary neurovascular bundle.  Mc = Musculocutaneous nerve, Me = Median nerve, U = Ulnar nerve, R = Radial nerve, A = Axillary artery, V = Axillary vein, B = Biceps brachii muscle, T = Triceps brachii muscle, C = Coracobrachialis, D = Deltoid muscle, H = Humerus, Dotted line = outline of Axillary sheath

The axillary block is highlighted in RED in this illustration depicting the sections of the brachial plexus and associated structures typically encountered during ultrasound guidance (dotted lines).  The terminal nerve branches visualized with ultrasound are encircled.  The axillary artery is also seen within this plane.  Note the proximity of the median, radial, and ulnar nerves to the axillary artery.  The axillary sheath (not pictured) encases these structures.  The musculocutaneous nerve is not contained within the sheath and must be anesthetized separately.  (UT = upper trunk, MT = middle trunk, IT = inferior trunk, ScA = Subclavian artery, AxA = Axillary artery, Mc = Musculocutaneous nerve, Me = Median nerve, R = Radial nerve, U = Ulnar nerve).

Did you get it right? The correct answer is C.

Incorrect Answer Explanations

Answer A: Hematoma may form secondary to puncture of the axillary artery.

Answers B & E: Systemic local anesthetic toxicity may occur as a result of intravascular injection.

Answer D: Postoperative neuropathy can result from nerve injury due to needle trauma or intraneural injection.

Bottom Line

Known complications of an axillary block include systemic local anesthetic toxicity, hematoma, and postoperative neuropathy.  Pneumothorax is a known complication of a SCB, not an axillary block.

For more information:

• Brown, Atlas of Regional Anesthesia, 3rd edition, pp. 63-70.
• Stoelting, Basics of Anesthesia, 5th edition, pp. 278-279.
• Atchabahian A. Ultrasound-Guided Supraclavicular block. Journal of the New York School of Regional Anesthesia (NYSORA), 13: 20-26 (2009).
• American Board of Anesthesiology Keyword. “Axillary Block: Complications”

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