Electron microscopy of human peripheral nerves of clinical relevance to the practice of nerve blocks. A structural and ultrastructural review based on original experimental and laboratory data.
OBJECTIVE
The goal is to describe the ultrastructure of normal human peripheral nerves, and to highlight key aspects that are relevant to the practice of peripheral nerve block anaesthesia.


METHODS
Using samples of sciatic nerve obtained from patients, and dural sac, nerve root cuff and brachial plexus dissected from fresh human cadavers, an analysis of the structure of peripheral nerve axons and distribution of fascicles and topographic composition of the layers that cover the nerve is presented. Myelinated and unmyelinated axons, fascicles, epineurium, perineurium and endoneurium obtained from patients and fresh cadavers were studied by light microscopy using immunohistochemical techniques, and transmission and scanning electron microscopy. Structure of perineurium and intrafascicular capillaries, and its implications in blood-nerve barrier were revised.


RESULTS
Each of the anatomical elements is analyzed individually with regard to its relevance to clinical practice to regional anaesthesia.


CONCLUSIONS
Routine practice of regional anaesthetic techniques and ultrasound identification of nerve structures has led to conceptions, which repercussions may be relevant in future applications of these techniques. In this regard, the ultrastructural and histological perspective accomplished through findings of this study aims at enlightening arising questions within the field of regional anaesthesia.
Department of Clinical Medical Sciences and Applied Molecular Medicine Institute, CEU San Pablo University School of Medicine, Madrid, Spain; Department of Anesthesiology, Madrid-Montepríncipe University Hospital, Madrid, Spain. Electronic address: miguelangel@perticone.e.telefonica.net.
M A
MA
Reina
R
R
Arriazu
C B
CB
Collier
X
X
Sala-Blanch
L
L
Izquierdo
J
J
de Andrés
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008854:Microscopy, Electron; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D010525:Peripheral Nerves / Q000648:ultrastructure*
Endoneurium; Endoneuro; Epineurium; Epineuro; Fascicles; Fascículos; Immunohistochemistry; Inmunohistoquímica; Microscopia electrónica de barrido; Microscopia electrónica de transmisión; Nerve; Nervios; Perineurium; Perineuro; Scanning electron microscopy; Transmission electron microscopy