• Victor Varela, Carlos Ruíz, Jaume Pomés, Isaac Pomés, Sara Montecinos, and Xavier Sala-Blanch.
• Master in Advanced Medical Skills in Regional Anesthesia based in Anatomy, University of Barcelona, Barcelona, Spain.
• Reg Anesth Pain Med. 2019 Aug 26.

IntroductionHigh-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.Methods21 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.ResultsICBN 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.ConclusionHRU 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.© American Society of Regional Anesthesia & Pain Medicine 2019. No commercial re-use. See rights and permissions. Published by BMJ.

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