Functional anatomy of the brachial plexus sheath: implications for anesthesia

Abstract

Anatomical study of the brachial plexus of 18 cadavers was undertaken to confirm the presence and significance of "septa" dividing the brachial plexus or axillary sheath. Dissection demonstrated that the sheath consists of multiple layers of thin connective tissue surrounding the various elements of the neurovascular bundle. These septa are incomplete, however, forming small bubble-like pockets when solution is injected. Single injections of methylene blue and Latex solutions into the axillary sheath resulted in immediate dye staining of median, radial, and ulnar nerves, despite the presence of septa. These data demonstrate that there are connections between compartments within the sheath and, therefore, do not support the need for multiple injections when performing an axillary block.