Asian Journal of Pharmaceutical Research and Health Care

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Site of Separation of Musculocutaneous Nerve from Axillary Brachial Plexus: Analysis using Ultrasound- Observational Volunteer Study


Affiliations
1 Department of Anaesthesiology and Critical care, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam – 607402, Puducherry, India
2 Department of Radiodiagnosis, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam – 607402, Puducherry
 

The axillary approach to brachial plexus blockade provides satisfactory anesthesia for elbow, forearm, and hand surgeries. The use of ultrasound enhances the success of such blocks. The major issue in such a block is the anatomical variation of the musculocutaneous nerve and its possible sparing. The unblocked lateral superficial tissues of forearm and the problem of tourniquet pain will come up if it’s spared. Hence in our study we wanted to locate the site of separation of the nerve. In eighty young healthy male volunteers, the scan of the right axillary area showed that the separation was proximal (point C) in 34% of cases to the classical described site (point A) of combined visualisation of conjoint tendon and axillary artery. It was found separating distally (point B) in 59 % of cases. The distance was maximal in the proximal group with 44 mm and in the distal group of 35 mm. It was absent in one individual. With such a large variation in anatomy, it is necessary to identify the musculocutaneous nerve separately and block it for a successful anesthetic journey in axillary approach to blocking brachial plexus.

Keywords

Anatomy, Axillary, Brachial Plexus, Musculocutaneous Nerve.
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  • Site of Separation of Musculocutaneous Nerve from Axillary Brachial Plexus: Analysis using Ultrasound- Observational Volunteer Study

Abstract Views: 266  |  PDF Views: 142

Authors

Balasubramanian Anusha
Department of Anaesthesiology and Critical care, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam – 607402, Puducherry, India
G. Jayaraman
Department of Radiodiagnosis, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam – 607402, Puducherry
S. Parthasarathy
Department of Anaesthesiology and Critical care, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam – 607402, Puducherry, India

Abstract


The axillary approach to brachial plexus blockade provides satisfactory anesthesia for elbow, forearm, and hand surgeries. The use of ultrasound enhances the success of such blocks. The major issue in such a block is the anatomical variation of the musculocutaneous nerve and its possible sparing. The unblocked lateral superficial tissues of forearm and the problem of tourniquet pain will come up if it’s spared. Hence in our study we wanted to locate the site of separation of the nerve. In eighty young healthy male volunteers, the scan of the right axillary area showed that the separation was proximal (point C) in 34% of cases to the classical described site (point A) of combined visualisation of conjoint tendon and axillary artery. It was found separating distally (point B) in 59 % of cases. The distance was maximal in the proximal group with 44 mm and in the distal group of 35 mm. It was absent in one individual. With such a large variation in anatomy, it is necessary to identify the musculocutaneous nerve separately and block it for a successful anesthetic journey in axillary approach to blocking brachial plexus.

Keywords


Anatomy, Axillary, Brachial Plexus, Musculocutaneous Nerve.

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DOI: https://doi.org/10.18311/ajprhc%2F2018%2F21525