title: Sonoanatomy of the vasculature at the supraclavicular and interscalene regions relevant for brachial plexus block.
abstract: BACKGROUND
  Our aim in this observational study was to utilize ultrasound, as well as anatomic dissection, to document the frequency with which branches of the subclavian vessels are found in close association with the brachial plexus at the locations of supraclavicular and interscalene brachial plexus block.
  
  
  METHODS
  Ultrasound was utilized to document the presence of branches of the subclavian vein and artery, adjacent to the brachial plexus in the supraclavicular and in the interscalene region in 50 patients undergoing shoulder surgery. The position, depth, and dimensions of the vessels were described, and the origin determined when possible. In addition, the posterior triangle of the neck on both sides of three non-preserved cadavers was dissected to evaluate the vascular anatomy and correlate the ultrasound findings.
  
  
  RESULTS
  Ultrasound scanning revealed an arterial branch adjacent to, or passing directly through, the brachial plexus in the supraclavicular region in 43/50 (86%) patients. Within the interscalene region, an artery was identified coursing in a lateral direction in 45/50 (90%) of cases, while a corresponding small vein, coursing medial to lateral in this area, was noted in 23/50 (46%) of cases.
  
  
  CONCLUSIONS
  Small branch vessels from the subclavian artery and vein were frequently evident, on ultrasound imaging, in close association with the nerve elements of the brachial plexus in the supraclavicular and interscalene regions. Appreciation of the presence of these vessels and their likely origin and course will aid the anesthesiologist in planning a safe nerve block.
authors.affiliation: Department of Anesthesiology, University of Pittsburgh School of Medicine, Pennsylvania, USA.
authors.forename: W T
authors.initials: WT
authors.lastname: Muhly
authors.forename: S L
authors.initials: SL
authors.lastname: Orebaugh
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy; D001917:Brachial Plexus / Q000033:anatomy & histology* / Q000098:blood supply / Q000000981:diagnostic imaging*; D002102:Cadaver; D002968:Clavicle / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D004210:Dissection; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D009407:Nerve Block / Q000379:methods*; D012039:Regional Blood Flow; D012782:Shoulder / Q000601:surgery; D013348:Subclavian Artery / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D013350:Subclavian Vein / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D014463:Ultrasonography