Analysis of the positional relationship of the long thoracic nerve considering clinical treatment.
injection point
long thoracic nerve
midaxillary line
serratus anterior
serratus anterior plane block
thoracotomy
Journal
Clinical anatomy (New York, N.Y.)
ISSN: 1098-2353
Titre abrégé: Clin Anat
Pays: United States
ID NLM: 8809128
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
revised:
22
06
2020
received:
15
03
2020
accepted:
03
07
2020
pubmed:
10
7
2020
medline:
21
10
2021
entrez:
10
7
2020
Statut:
ppublish
Résumé
The long thoracic nerve (LTN) has a risk of being damaged during chest surgery and should be considered when performing anesthesia such as a serratus anterior plane block (SAPB). We analyzed the relationship between landmarks-the fourth to ninth intercostal space (ICS) at the midaxillary line (MAL), through which the distal part of the LTN passes-and the LTN. We used 25 specimens from 17 embalmed Korean cadavers. The MAL, level of rib and ICS, and regions 5 cm anteroposterior to the MAL (aMAL/pMAL) were established to measure the position of the LTN crossing the MAL, pathway of the LTN, and entering points of the LTN to the SA. The LTN crossed the MAL in 76% of the specimens. The LTN crossed the MAL within the fifth to sixth rib level in 70.8%. Seventy-six percent of the branches entered the SA within the fourth to sixth ICS. The fifth rib and ICS were the most frequent regions aMAL; however, several branches were found pMAL. The LTN entered the SA in 92.6% of the specimens within 3 cm anterior and 1 cm posterior to the MAL. We set the danger zone as 4 cm near the MAL at the fourth to sixth ICS for thoracotomy. In addition, we proposed the fifth ICS in aMAL at the superficial plane as the alternative injection point for SAPB when blocking the LTN, and the fifth ICS in pMAL at the deep plane to prevent blocking the LTN.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
617-623Subventions
Organisme : Yonsei University College of Medicine
ID : 6-2019-0181
Informations de copyright
© 2020 Wiley Periodicals LLC.
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