Anatomical basis for ultrasound-guided regional anaesthesia at the junction of the axilla and the upper arm

Abstract

Ultrasound (US) has emerged in the field of regional anaesthesia in the past few years, as it allows physicians to simultaneously see the needle, the targeted nerves, and the vessels to avoid. Nevertheless, anatomical knowledge is essential for identifying all of the structures seen on the US screen. US also allows an in vivo approach to the variations of nerves and vessels. The aim of this study was to describe the anatomical structures of the axilla through a dissection, an anatomical section and US images performed during daily regional anaesthesia. This work will also discuss the usefulness of US in studying anatomical variations of vasculonervous structures. The axillary region of an embalmed adult cadaver was dissected in the department of Anatomy, and anatomical sections of another embalmed and frozen cadaver were also performed. During the same period, fortuitous anatomical variations discovered during daily routine axillary US-guided nerve blocks were recorded in the department of Anaesthesiology. The anatomical dissection and sections allowed correlations to be made and structures to be identified on the US images. The most frequent anatomical variations found were double axillary artery, numerous axillary veins, variant location of the musculocutaneous nerve and posterior location of the brachial plexus in relation to the axillary artery. Anatomical knowledge is of major importance for US-guided regional anaesthesia. US scan offers a new approach to anatomical variations of the vasculonervous bundle at the junction of the axilla and the upper arm.