Anesth Pain Med.  2016 Apr;11(2):207-210. 10.17085/apm.2016.11.2.207.

Bilateral variant locations of the musculocutaneous nerve during ultrasound-guided bilateral axillary brachial plexus block: A case report

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Inha University School of Medicine, Incheon, Korea. everycw@daum.net

Abstract

Ultrasound-guided peripheral nerve block has several advantages over traditional techniques for nerve localization. One is a reduction of local anesthetic dose required for successful nerve block, which might allow bilateral brachial plexus block to be performed without risk of local anesthetic toxicity. Another advantage is the ability to detect anatomical variations in nerve and vascular anatomy. We report the case of a patient with unilateral anatomical variations of the musculocutaneous nerve found in ultrasound-guided bilateral axillary brachial plexus block.

Keyword

Anatomic variation; Brachial plexus block; Musculocutaneous nerve; Nerve block

MeSH Terms

Anatomic Variation
Brachial Plexus*
Humans
Musculocutaneous Nerve*
Nerve Block
Peripheral Nerves

Figure

  • Fig. 1 Ultrasound image of right axillary region. The large structure (arrow) appears to consist of the musculocutaneous nerve and median nerve. Abbreviations: V = vein; A = artery; U = ulnar nerve; and R = radial nerve.

  • Fig. 2 Ultrasound image of left axillary region. The musculocutanoeus nerve (arrow) was localized between the coracobrachialis and biceps muscles.


Reference

1. Marhofer P, Schrögendorfer K, Wallner T, Koinig H, Mayer N, Kapral S. Ultrasonographic guidance reduces the amount of local anesthetic for 3-in-1 blocks. Reg Anesth Pain Med. 1998; 23:584–8. DOI: 10.1016/S1098-7339(98)90086-4. PMID: 9840855.
Article
2. Kessler J, Gray AT. Sonography of scalene muscle anomalies for brachial plexus block. Reg Anesth Pain Med. 2007; 32:172–3. DOI: 10.1097/00115550-200703000-00019. PMID: 17350535.
Article
3. Royse CE, Sha S, Soeding PF, Royse AG. Anatomical study of the brachial plexus using surface ultrasound. Anaesth Intensive Care. 2006; 34:203–10. PMID: 16617641.
Article
4. Gutton C, Choquet O, Antonini F, Grossi P. Ultrasound-guided interscalene block: Influence of anatomic variations in clinical practice. Ann Fr Anesth Reanim. 2010; 29:770–5. DOI: 10.1016/j.annfar.2010.07.013. PMID: 20934304.
5. Berthier F, Lepage D, Henry Y, Vuillier F, Christophe JL, Boillot A, et al. Anatomical basis for ultrasound-guided regional anaesthesia at the junction of the axilla and the upper arm. Surg Radiol Anat. 2010; 32:299–304. DOI: 10.1007/s00276-009-0539-2. PMID: 19669074.
Article
6. Uysal II, Karabulut AK, Büyükmumcu M, Unver Dogan N, Salbacak A. The course and variations of the branches of the musculocutaneous nerve in human fetuses. Clin Anat. 2009; 22:337–45. DOI: 10.1002/ca.20734. PMID: 19090002.
Article
7. Choi D, Rodríguez-Niedenführ M, Vázquez T, Parkin I, Sañudo JR. Patterns of connections between the musculocutaneous and median nerves in the axilla and arm. Clin Anat. 2002; 15:11–7. DOI: 10.1002/ca.1085. PMID: 11835538.
Article
8. Prasada Rao PV, Chaudhary SC. Absence of musculocutaneous nerve: two case reports. Clin Anat. 2001; 14:31–5. DOI: 10.1002/1098-2353(200101)14:1<31::AID-CA1005>3.0.CO;2-Y.
Article
9. Sia S, Lepri A, Marchi M. Axillary block by “selective” injections at the nerves involved in surgery using a peripheral nerve stimulator: a comparison with a “standard” triple-injection technique. Reg Anesth Pain Med. 2010; 35:22–7. DOI: 10.1097/AAP.0b013e3181c6f395. PMID: 20052813.
10. Remerand F, Laulan J, Couvret C, Palud M, Baud A, Velut S, et al. Is the musculocutaneous nerve really in the coracobrachialis muscle when performing an axillary block? An ultrasound study. Anesth Analg. 2010; 110:1729–34. DOI: 10.1213/ANE.0b013e3181dc25c8. PMID: 20435937.
Article
11. Orebaugh SL, Pennington S. Variant location of the musculocutaneous nerve during axillary nerve block. J Clin Anesth. 2006; 18:541–4. DOI: 10.1016/j.jclinane.2006.03.010. PMID: 17126786.
Article
12. Beach ML, Sites BD, Gallagher JD. Use of a nerve stimulator does not improve the efficacy of ultrasound-guided supraclavicular nerve blocks. J Clin Anesth. 2006; 18:580–4. DOI: 10.1016/j.jclinane.2006.03.017. PMID: 17175426.
Article
13. Kim BS, Kwak HS. Bilateral interscalene brachial plexus block for surgery on both upper extremities in a patient with unilateral vocal cord paralysis. Anesth Pain Med. 2007; 2:270–3.
14. O’Donnell BD, Ryan H, O’Sullivan O, Iohom G. Ultrasound-guided axillary brachial plexus block with 20 milliliters local anesthetic mixture versus general anesthesia for upper limb trauma surgery: an observer-blinded, prospective, randomized, controlled trial. Anesth Analg. 2009; 109:279–83. DOI: 10.1213/ane.0b013e3181a3e721. PMID: 19535722.
Article
Full Text Links
  • APM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr