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• Complete anatomy brachial plexus skin#

However, intravascular injection is more common in this approach compared with other approaches. Complications that may occur are specific to each terminal nerve.

The axillary brachial plexus block is performed at the level of the terminal branches of the BP and may require multiple injections. Complications that can occur include chylothorax, which is a rare complication that occurs when performing left-sided blocks, and pneumothorax, which occurs more frequently as compared with the supraclavicular approach. This approach is often used for the placement of indwelling catheters as the infraclavicular site provides stable positioning. The infraclavicular approach targets the cords of the BP and is indicated for surgery of the distal arm, elbow, forearm and hand. The most common complications for this approach include hemi-diaphragmatic paralysis and Horner’s syndrome, which are directly related to the volume of local anaesthetic used. Therefore, this approach is not recommended for surgery of the forearm or hand. Although this groove is easy to locate, the local anaesthetic does not sufficiently anaesthetise the inferior trunk. The interscalene BP block, which is indicated for surgery of the shoulder region, clavicular area, arm and elbow joint, is performed in the interscalene groove. 2Īlternative approaches include the interscalene, infraclavicular and axillary BP nerve blocks. 1 According to the literature, the supraclavicular approach proves to be one of the safest and most effective techniques. The supraclavicular block also has the most widespread extent of sensory blockade among all the BP approaches and is ideal for providing dense, rapid onset, and efficient anaesthesia and analgesia for procedures from the shoulder joint and mid-humerus proximally, to the hand distally. 1 Due to the limited surface area, the entire BP is anaesthetised.

Complete anatomy brachial plexus skin#

1 With this approach, the trunks/divisions of the BP are compact and superficial to the skin making it easy to visualise on ultrasound. The data presented here provide a rational explanation for the not uncommon occurrence of a profound block of rapid onset in one nerve, yet partial or absent block in other nerves, following any of the techniques of brachial plexus anesthesia.The supraclavicular approach to the brachial plexus block was first described in the early twentieth century and is arguably the most preferred brachial plexus (BP) approach with the highest success rate. These studies also indicate that injected anesthetic solutions spread easily in a longitudinal manner up and down the nerve and remain compartmentalized. They serve functionally to limit the circumferential spread of injected solutions of local anesthetics. These compartments have potential clinical importance and implication in the techniques for brachial plexus block. A fascial compartment is created for each nerve, and this compartment serves to define the anatomic limits of that nerve. Thus, the sheath is a multicompartmented structure, formed by the thin connective tissue sheath surrounding the plexus and by the septa which extend inward from the sheath. The connective tissue forming the sheath extends inward, forming septa between components of the plexus.

The connective tissue forming the sheath was organized more densely proximally near its origin and became loosely organized distally as it ended by joining the medial intermuscular septum of the arm.

The brachial plexus sheath was examined in cadavers by using a combination of anatomic dissection, histologic preparations, and x-rays made after injection of x-ray contrast media, and in surgical patients by using computed tomography (CT) dye studies.