[Endoscopic anatomy of the axillary brachial plexus: examination of cadavers and implications for anesthesia].
OBJECTIVE
To identify the structures of the brachial plexus using fiberoptic techniques, determine the most useful approach, and visualize the introduction of instruments used in anesthesia.


METHODS
Formalin-treated a ndcryopreserved cadavers were studied with a 4-mm fiberoptic endoscope, an arthroscope for small joints, and nerve-stimulation needles through which a catheter could be introduced. The arm and elbow were dissected to isolate the humeral artery and the medial, radial, and cubital nerves. The fiberoptic endoscope was advanced along each nerve until the axilla, where the neurovascular structures of the plexus were identified. The axilla was punctured with a nerve stimulation needle and the catheter was passed through the needle while its movement was observed with the fiberoptic endoscope. Then, the axilla was punctured with the arthroscope as if it were the needle.


RESULTS
In cryopreserved and formalin-treated cadavers, the fiberoptic endoscope could be passed as far as the axilla by following the medial nerve but not by following the cubital or radial nerves. We were able to identify the humeral artery and medial nerve in the axilla and to observe entry of the needle and progression of the catheter. The arthroscope could be introduced in the axilla as if it were a needle and the humeral artery and medial nerve could be identified.


CONCLUSIONS
The inside of the neurovascular bundle of the brachial plexus can be visualized using afiberoptic endoscope advanced from the elbow or using an arthroscope introduced in the axilla. Although we are a long way from being able to see what we are doing, this is a first step towards direct visualization of the major structures of the axillary brachial plexus.
Morros
C
C
Servicio de Anestesiología, Reanimación y Terapia del Dolor, Midat Cyclops Mutual, Barcelona. 18450cmv@comb.es
Pérez-Cuenca
M D
MD
Sala-Blanch
X
X
Carrera
A
A
D000758:Anesthesia; D001917:Brachial Plexus / Q000033:anatomy & histology*; D002102:Cadaver; D004724:Endoscopy; D006801:Humans