The sheath of the brachial plexus: fact or fiction?

Abstract:

BACKGROUND:The concept of the axillary "sheath" has been a central tenet of brachial plexus regional anesthesia for many years. Recent investigations have cast doubt on its nature and existence. This study further examines the issue. METHODS:Computerized axial tomographic dye studies were performed using continuous catheter systems for the sciatic nerve and the brachial plexus. The resultant images were compared and contrasted. RESULTS:The images of the two catheter systems were the same, with the exception that one was of the upper extremity and the other was of the lower extremity. CONCLUSIONS:The sciatic nerve is not surrounded or enveloped by a "sheath"--it lies in the tissue plane between rigid anatomical structures. Similarly, the brachial plexus lies in the tissue plane between the rigid anatomy of the chest wall, scapula, humerus, and pectoral fascia. This finding is inconsistent with the concept of the axillary sheath.

journal_name

Anesthesiology

journal_title

Anesthesiology

authors

Cornish PB,Leaper C

doi

10.1097/00000542-200609000-00021

subject

Has Abstract

pub_date

2006-09-01 00:00:00

pages

563-5

issue

3

eissn

0003-3022

issn

1528-1175

pii

00000542-200609000-00021

journal_volume

105

pub_type

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