title: The relationship of the musculocutaneous nerve to the brachial plexus evaluated by MRI.
abstract: Axillary plexus blocks (AXB) are widely used for upper limb operations. It is recommend that AXB should be performed using a multiple injection technique. Information about the course and position of the musculocutaneous nerve (MCN) is of relevance for AXB performance. The objective of this study was to examine the position of the MCN and its relationship to the axillary sheath using MRI. 54 patients underwent an AXB with 40 ml of local anaesthetic before MRI examination. The course of the MCN and the position where it left the axillary sheath and perforated the coracobrachial muscle (MCN exit point), in relation to the axillary artery and the block needle insertion point in the axillary fold, were recorded. The MCN was seen clearly in 23, partly in 26, and not identified in five patients at the MCN exit point. The mean distance from the insertion point of the block needle in the axillary fold to the MCN exit point was 36.8 mm (SD = 18.9, range: 0-90.5). In 37 patients the MCN exit point was positioned inside the Q1quadrant (lateral anterior to the axillary artery) and in 11 patients inside the Q2quadrant (medial anterior to the axillary artery). There is a wide variability as to where the musculocutaneous nerve (MCN) leaves the axillary sheath. Therefore multiple injection techniques, or the use of a proximally directed catheter, should be appropriate to block the MCN.
authors.affiliation: Department of Anaesthesiology, Diakonhjemmet Hospital, Pb 23 Vinderen, 0319, Oslo, Norway. trygve.kjelstrup@labmed.uio.no.|The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway. trygve.kjelstrup@labmed.uio.no.
authors.forename: Trygve
authors.initials: T
authors.lastname: Kjelstrup
authors.affiliation: Division of Emergencies and Critical Care, Department of Anaesthesiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Axel R
authors.initials: AR
authors.lastname: Sauter
authors.affiliation: The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Per K
authors.initials: PK
authors.lastname: Hol
mesh_terms: D000777:Anesthetics / Q000627:therapeutic use; D000779:Anesthetics, Local; D001917:Brachial Plexus / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007267:Injections; D008279:Magnetic Resonance Imaging; D018482:Muscle, Skeletal / Q000473:pathology; D009138:Musculocutaneous Nerve / Q000000981:diagnostic imaging* / Q000473:pathology; D009407:Nerve Block / Q000379:methods; D010865:Pilot Projects
chemical_list: D000777:Anesthetics; D000779:Anesthetics, Local
keywords: Brachial plexus; MRI scan; Musculocutaneous nerve