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Evaluation of anatomic landmarks for axillary nerve block in the quadrilateral space

 Y. A. KIM  ;  K. B. YOON  ;  T. D. KWON  ;  D. H. KIM  ;  D-M. YOON 
 Acta Anaesthesiologica Scandinavica, Vol.58(5) : 567-571, 2014 
Journal Title
 Acta Anaesthesiologica Scandinavica 
Issue Date
Adolescent ; Adult ; Aged ; Anatomic Landmarks* ; Anthropometry ; Axilla/innervation* ; Female ; Humans ; Humerus/diagnostic imaging ; Male ; Middle Aged ; Nerve Block/methods* ; Pain, Postoperative/prevention & control ; Peripheral Nerves/anatomy & histology* ; Pulse ; Sex Characteristics ; Shoulder/blood supply ; Shoulder/diagnostic imaging ; Shoulder/innervation* ; Shoulder/surgery ; Ultrasonography, Doppler ; Young Adult
BACKGROUND:Axillary nerve block (ANB) was recently introduced along with suprascapular nerve block as an alternative to inter-scalene brachial plexus block for post-operative pain control. However, the methods for performing ANB are variable. We studied the relationship between surface anatomy and the location of the axillary nerve in the quadrilateral space to ensure a technically safe and simple ANB. METHODS:Eighty-eight shoulders were included. All measurements were performed with the subjects seated and the shoulders in a neutral position. We located the posterior circumflex humeral artery (PCHA) using a vascular Doppler system and named this point 'AN'. We used this point to locate the axillary nerve, since this nerve is generally present with the PCHA in the quadrilateral space. We then examined the relationship between surface anatomic landmarks and AN. The depth of the medial side of the humerus at the AN (AN depth), which is at the lateral border of the quadrilateral space, was measured using ultrasonography. RESULTS:AN was located on the line between the posterolateral corner of the acromion (Ac) and the axillary fold (Axf) (Ac-Axf) in 77% of shoulders. The ratio of the distance from Ac to AN (Ac-AN) to Ac-Axf in all shoulders was 0.6 [standard deviation (SD), 0.1]. AN depth was 4.0 (SD, 0.5) cm in men and 3.6 (SD, 0.4) cm in women. CONCLUSION:Knowledge of the relationship between surface anatomy and AN, as well as estimated AN depth may aid in locating the axillary nerve in the quadrilateral space.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kweon, Tae Dong(권태동) ORCID logo https://orcid.org/0000-0002-5451-1856
Kim, Do Hyeong(김도형) ORCID logo https://orcid.org/0000-0003-2018-8090
Kim, Yeon A(김연아)
Yoon, Kyoung Bong(윤경봉) ORCID logo https://orcid.org/0000-0002-4167-1375
Yoon, Duck Mi(윤덕미)
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