Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942007000600012
Brazilian Journal of Anesthesiology
Miscellaneous

Imagens ultra-sonográficas do plexo braquial na região axilar

Ultrasound images of the brachial plexus in the axillary region

Diogo Brüggemann da Conceição; Pablo Escovedo Helayel; Francisco Amaral Egydio de Carvalho; Jaderson Wollmeister; Getúlio Rodrigues de Oliveira Filho

http://dx.doi.org/10.1590/S0034-70942007000600012 Braz J Anesthesiol, vol.57, n6, p.684-689, 2007
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Resumo

JUSTIFICATIVA E OBJETIVOS: A artéria axilar é referência anatômica de superfície para o bloqueio do plexo braquial por via axilar. Estudos anatômicos sugerem variabilidade das posições das estruturas nervosas do plexo braquial em relação à artéria. Essas variações podem dificultar bloqueios por neuroestimulação. A ultra-sonografia permite a identificação das estruturas do plexo braquial ¹. Este estudo visou a descrever o posicionamento dos nervos do plexo braquial em relação à artéria axilar. MÉTODO: Foram estudados 30 voluntários de ambos os sexos, em posição supina com abdução a 90º e rotação externa do ombro e flexão do cotovelo a 90º. Utilizando transdutor digital de 5 cm e 5-10 MHz, foram identificados os nervos mediano, ulnar e radial e as respectivas posições em relação à artéria foram marcadas em uma carta gráfica seccional de oito setores, numerados em ordem crescente a partir da hora 12 (medial), cujo centro representava a artéria axilar. RESULTADOS: O nervo mediano localizou-se predominante no setor 8 (55%) e no setor 1 (28%) (mediais); o nervo radial localizou-se predominantemente nos setores 4 (59%) e 5 (34%) (laterais) e o nervo ulnar nos setores 2 e 3 (inferiores) em 69% e 24% dos casos, respectivamente. Houve considerável variação da localização dos nervos em relação aos aspectos superior e inferior da artéria. CONCLUSÕES: A inspeção em tempo real, por ultra-som, das estruturas neurovasculares do plexo braquial na axila mostrou que os nervos mediano, ulnar e radial podem apresentar diferentes relações com a artéria axilar.

Palavras-chave

ANATOMIA, ULTRA-SONOGRAFIA

Abstract

BACKGROUND AND OBJECTIVES: The axillary artery is the anatomical reference, in the surface, for axillary brachial plexus block. Anatomic studies suggest variability in the location of the structures in the brachial plexus in relation to the axillary artery. These variations can hinder blocks by neurostimulation. The ultrasound allows the identification of the structures within the brachial plexus¹. The objective of this report was to describe the position of the nerves in the brachial plexus in relation to the axillary artery. METHODS: Thirty volunteers of both genders were studied. They were in the supine position with 90° abduction and external rotation of the shoulder and 90º flexion of the elbow. Using a 5 cm and 5-10 MHz digital transducer, median, ulnar and radial nerves were identified and their position in relation to the artery were recorded in an 8-sector sectional graphic chart, numbered in crescent order starting at the 12-hour position (medial), whose center represented the axillary artery. RESULTS: The median nerve was located mainly in sectors 8 (55%) and 1 (28%) (medial); the radial nerve was predominantly in sectors 4 (59%) and 5 (34%) (lateral); and the ulnar nerve in sectors 2 and 3 (inferior) in 69% and 24% of the cases, respectively. There was a considerable variation in the location of the nerves in relation to the superior and inferior aspects of the artery. CONCLUSIONS: Real-time ultrasound inspection of the neurovascular structures of the brachial plexus in the axilla demonstrated that the median, ulnar and radial nerves have different relations with the axillary artery.

Keywords

ANATOMY, ULTRASOUND

References

Retzl G, Kapral S, Greher M. Ultrasonographic findings of the axillary part of the brachial plexus. Anesth Analg. 2001;92:1271-1275.

De Andrés J, Sala-Blanch X. Ultrasound in the practice of brachial plexus anesthesia. Reg Anesth Pain Med. 2002;27:77-89.

Ting PL, Sivagnanaratnam V. Ultrasonographic study of spread of local anaesthetic during axillary brachial plexus block. Br J Anaesth. 1989;63:326-329.

Partridge BL, Katz J, Benirschke K. Functional anatomy of the brachial plexus sheath: implication for anesthesia. Anesthesiology. 1987;66:743-747.

Silvestri E, Martinoli C, Derchi LE. Echotexture of peripheral nerves: correlation between US and histologic findings and criteria to differentiate tendons. Radiology. 1995;197:291-296.

Yang WT, Chui PT, Metreweli C. Anatomy of the normal brachial plexus revealed by sonography and the role of sonographic guidance in anesthesia of the brachial plexus. AJR. 1998;171:1631-1636.

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