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Title
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Topographic assessment of the medial antebrachial cutaneous nerve at the axilla relative to the axillary artery and vein using ultrasonography
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Author
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Abstract
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| Introduction : The medial antcbrachial cutaneous nerve (MACN) can be identified using ultrasound (US). Its identification can prevent unintended injury and provide selective targeting when preforming an axillary brachial plexus blockade (BPB). The primary aim is to assess the topographic variation of the MACN at the axilla. Secondary objectives include ; topographic mapping of the terminal nerves and BPB success rate analysis. Methods : After approval by local ethics committee of the Antwerp University Hospital, 35 patients were included in this observational study after providing informed consent. The MACN and terminal nerves were identified at the axilla using dynamic US examination. Images of the plexus were stored and the distribution relative to the AA and AV was analyzed using a 12-section pie-chart. The distance between the MACN and AV was measured. A five-injection BPB was preformed and tested after 20 minutes using cold sensation and evaluation of motor function. Results : The MACN was identified in all cases and found in the upper right quadrant to the AA in 97% of cases and upper left quadrant to the AV in 73%. The mean distance between the MACN and AV was 1.3 mm (95% CI 0.6-2.0mm). The analyzed distributions of the other terminal nerves were plotted. All nerves were successfully blocked, including the MACN. Conclusions : The MACN was identified in all cases, mostly superficial and medial to the AA, superficial and lateral to the AV, and adjacent to the AV. This might help to identify the MACN during axillary BPB to either avoid injury or for selective targeting. Distribution of the larger terminal nerves relative to the AA was comparable to literature. No conclusions were made about the directional topographic distribution of the larger terminal nerves relative to the AV. |
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Language
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English
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Source (journal)
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Acta anaesthesiologica belgica / Belgische Vereniging voor Anesthesie en Reanimatie; Society for Anesthesia and Resuscitation of Belgium. - Brussel, 1950, currens
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Publication
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Brussel
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2020
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ISSN
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0001-5164
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Volume/pages
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71
:s:[1]
(2020)
, p. 79-86
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ISI
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000641759600011
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