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Skeletal Radiol (2013) 42:707713 DOI 10.1007/s00256-013-1578-7
SCIENTIFIC ARTICLE
Ultrasound anatomy of the brachial plexus nerves in the neurovascular bundle at the axilla in patients undergoing upper-extremity block anesthesia
Evren Ustuner & Ayse Ylmaz & Enver zgencil &
Feyhan Okten & Sanem Cakar Turhan
Received: 14 October 2012 /Revised: 7 December 2012 /Accepted: 7 January 2013 /Published online: 7 February 2013 # ISS 2013
AbstractPurpose Familiarity with the localization of the nerves in the neurovascular bundle that constitutes the axillary segment of the brachial plexus (BP) is important when applying ultrasound (US)-guided block anesthesia. Therefore in this study we aimed to delineate the anatomy of the median, radial, and ulnar nerves of the BP at the axilla with US and electrical stimulation.
Materials and methods The study included 60 patients who were scheduled to undergo upper-arm surgery with axillary block anesthesia. Prior to anesthesia, ulnar, radial, and median nerves were localized with US using a 12-h quadrant identification system that placed the axillary artery (AA) in the middle. The nerves were then functionally tested using a neurostimulator.
Results The radial nerve was mainly located in the 46 oclock arc (posterior and posteromedial to AA) in 50 (83 %) of patients. Ulnar nerve was mainly at the 123 oclock arc (anteromedial to AA) in 51 (85 %) of patients. Ulnar nerve showed a second peak at 910 oclock quadrant (anterolateral to AA) in 11 % (7) of patients. Median nerve location was most common in the 12 and 9 oclock arc (anterior and anterolateral to AA) in 53 (88 %) of the patients.
Conclusions Ultrasound is a useful tool for depicting BP anatomy in the axillary fossa prior to block anesthesia. Median, ulnar, and radial nerves form a highly consistent triangular pattern around the axillary artery that is easily recognizable with US.
Keywords Brachial plexus . Ultrasound . Electrical stimulation . Axilla block anesthesia
Introduction
The brachial plexus (BP) is a complex anatomical nerve network formed by the upper-extremity C5-T1 nerve roots in the axillary fossa and the supraclavicular region. The functional anatomy and the location of the nerves that constitute the BP and the nervous connections at the axillary region come to clinical attention especially when upper-extremity surgery and peripheral block anesthesia are concerned [1].
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