The evolving role of the axillary nerve in regional anesthesia (NYSORA)
Rethinking shoulder analgesia: the evolving role of the axillary nerve in regional anesthesia
NYSORA這篇文章針對Michelle Chong團隊近期的這篇education article,
給了很完整的整理和回顧，主角是axillary nerve。
以下為本文章提供的重要資訊
Superfical sensory innervation of shoulder region:
-Supraclavicular nerves (C3–C4) from the cervical plexus
-Axillary nerve (C5–C6)
Deep articular innervation
-Suprascapular nerve
-Lateral pectoral nerve
-Subscapular nerves
-Axillary nerve
Axillary nerve你應該要知道的事
posterior cord of the brachial plexus & fibers from C5-C6
Anatomy pathway:
1. Emerges from the posterior cord of the brachial plexus
2. Passes between the pectoralis minor and serratus anterior muscles
3. Travels along the anterior surface of the subscapularis muscle
4. Enters the quadrangular space alongside the posterior circumflex humoral artery
5. Wraps around the surgical neck of the humerus
6. Divides into anterior and posterior branches
Quadrangular spac的邊界
~Superior: teres minor and subscapularis
~Inferior: teres major
~Medial: long head of the triceps
~Lateral: surgical neck of the humerus
Axillary nerve和PCHA (posterior circumflex humeral artery)會經過這個空間，
這篇文章介紹了四個axillary nerve intervention的視窗，
其中posterior quadrangular space是最常被應用的位置，原因如下:
1。超音波容易找到
2。有伴隨的PCHA來當做參考
3。坐姿或側身都可以執行
Shouler block with suprascapular & axillary nerve的好處
~Provides improved postoperative analgesia
~Reduces opioid consumption
~Lowers complication rates compared with the interscalene block
This approach may be particularly beneficial for patients with respiratory disease.
想了解更多，建議去看一下NYSORA的這篇整理，
也可以去找一下出處文章好好看一看。
以下這段影片就是由後側來找到axillary nerve的示範，
由humeral head -neck往shaft走，找到PCHA，就在這喔。
Axillary nerve: what anesthesiologists and pain physicians should know