Figure 1-10 A, Hirschel performed the first percutaneous axillary block with 20 mL of 2% procaine in 1911. He forced a rubber ball under the pectoral muscles and fixed it with elastic bandages to prevent rapid absorption of anesthetic solution, a maneuver that he later abandoned as unnecessary. (From Hirschel G: Die Anasthesierung de Plexus Brachialis fur die Operationen an der oberen Extremitat, Much Med Wochenschr 58:1555–1556, 1911.) B, Kulenkampff approached the brachial plexus above the clavicle, just lateral to the subclavian artery. The patients were positioned in the sitting position for the block. An injection of 10 mL of 2% procaine with epinephrine was given only after a paresthesia had been obtained. If the first rib was contacted, the injection was made more medially. (From Kulenkampff D: Anesthesia of the brachial plexus. Zentrabl Chr 38:1337–1340, 1911.)