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BJA Advance Access originally published online on August 21, 2009
British Journal of Anaesthesia 2009 103(4):606-612; doi:10.1093/bja/aep207
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Assessment of topographic brachial plexus nerves variations at the axilla using ultrasonography

J.-L. Christophe1,{dagger}, F. Berthier1,{dagger}, A. Boillot1, L. Tatu2, A. Viennet1, N. Boichut1 and E. Samain1,*

1 Department of Anaesthesiology and Intensive Care Medicine and
2 Department of Anatomy, Jean Minjoz Hospital, University of Franche Comte, 3 Bvd Alexander Fleming, 25000 Besancon, France

* Corresponding author. E-mail: anesthesiologie{at}chu-besancon.fr

Background: The aim of this study was to describe topographic variations in the arrangement of the four main brachial plexus nerves at the junction of the axilla and the upper part of the arm.

Methods: In 153 patients undergoing upper arm surgery using axillary block, we studied nerve arrangements with a three-step approach, combining: (A) cross-sectional ultrasound imaging using a 12 MHz linear ultrasound probe; (B) distal shift of the ultrasound scanhead from the axilla to the elbow joint following the paths of individual nerves; and (C) identifying the distal motor response to electrical nerve stimulation of each nerve. These results were then converted into a 12-section pie chart with the axillary artery (AA) as the axis.

Results: The order of the nerves around the AA was median, ulnar, radial, and musculocutaneous in all cases. The most frequent arrangement was observed in 65% of the patients. Five less frequent variations were observed in 4–20% of the patients, with four other variations seen in <2% of the patients. In 78% of the cases, the four nerves were seen separately using static ultrasound imaging. The musculocutaneous nerve was close to the artery in 18% of the patients.

Conclusions: Topographic variations of the four main nerves at the axilla were found to be numerous, the most frequent arrangement being seen in less than two-thirds of the patients. Four separate nerves were seen on static ultrasound imaging at this sectional level of the axilla in only 78% of the cases.

Keywords: anaesthetic techniques, regional, brachial plexus; anatomy, axillary brachial plexus; equipment, ultrasound machines

{dagger} These authors contributed equally to this work.


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