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Usefulness of high-resolution ultrasound for small nerve blocks: visualization of intercostobrachial and medial brachial cutaneous nerves in the axillary area
  1. Victor Varela1,
  2. Carlos Ruíz1,
  3. Jaume Pomés2,
  4. Isaac Pomés2,
  5. Sara Montecinos3 and
  6. Xavier Sala-Blanch4,5
  1. 1Master in Advanced Medical Skills in Regional Anesthesia based in Anatomy, University of Barcelona, Barcelona, Spain
  2. 2Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain
  3. 3Department of Anesthesiology, Clinica MEDS, Las Condes, Chile
  4. 4Department of Anesthesia, Hospital Clinic, University of Barcelona, Barcelona, Spain
  5. 5Department of Embryology and Human Anatomy, Faculty of Medicine, Universitat of Barcelona, Barcelona, Spain
  1. Correspondence to Dr Xavier Sala-Blanch, Anesthesia, Hospital Clinic, University of Barcelona, Barcelona 08036, Spain; xavi.sala.blanch{at}


Introduction High-resolution ultrasound (HRU) allows one to identify small nerves, but in the clinical setting, intercostobrachial nerve (ICBN) and medial brachial cutaneous nerve (MBCN) are not identified with conventional portable ultrasound (CPU) devices. The aim of this study is to identify both nerves and describe their relation with specific anatomical structures which could be easily identified with the ultrasound devices available in the clinical setting.

Methods 21 healthy patients were scanned using HRU bilaterally in the axillary area located over the conjoint tendon to find the ICBN and MBCN and describe their anatomic relations. 5 fresh cadavers were used to validate the previous anatomical findings. ICBN and MBCN ultrasound-guided block was performed with 5 mL of methylene blue and iodine contrast, and the distribution was assessed by both CT scan and dissection.

Results ICBN and MBCN were identified in all cases. The average distance of the ICBN branches to the artery was 35±6 mm in men and 27±5 mm in women. Constant identification of the muscle–tendon junction of the latissimus dorsi muscle with respect to the location of the branches of the ICBN nerve was observed. Dissection and CT scan confirmed these findings.

Conclusion HRU is a useful tool to identify ICBN and MBCN nerves, and to describe structures which can be easily identified with CPU use in the clinical setting.

  • brachial plexus
  • anatomy
  • technology

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  • Contributors All authors have participated in the study design and conduction, have read and approved the document, meet the authorship requirements, have no disclosures, consider that the manuscript represents an honest work, and all the ethical principles of the World Medical Association and the Declaration of Helsinki have been fully respected. VV: This author participated in study design, conduction, data collection, data analysis, and manuscript preparation. Attestation: VV approved the final manuscript. CR: This author participated in study conduction, data collection, and manuscript preparation. Attestation: CR approved the final manuscript. JP: This author participated in study conduction, data collection, and data analysis. Attestation: JP approved the final manuscript. IP: This author participated in study conduction and data collection. Attestation: IP approved the final manuscript. XS-B: This author designed the study, participated in study conduction, data collection, data analysis, and manuscript preparation. Attestation: XS-B approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.