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New insights into pathways of the accessory nerve and transverse cervical artery for distal selective accessory nerve blockade

Korean Journal of Pain 2020년 33권 1호 p.48 ~ 53
허양욱 ( Heo Yang-Uk ) - Wonkwang University School of Medicine Department of Anatomy

조남주 ( Cho Nam-Ju ) - Wonkwang University School of Medicine Department of Anatomy
조현호 ( Cho Hyun-Ho ) - Wonkwang University School of Medicine Wonkwang University Hospital Department of Anesthesiology and Pain Medicine
원형선 ( Won Hyung-Sun ) - Wonkwang University School of Medicine Department of Anatomy
양미영 ( Yang Mi-Young ) - Wonkwang University School of Medicine Department of Anatomy
김연동 ( Kim Yeon-Dong ) - Wonkwang University School of Medicine Wonkwang University Hospital Department of Anesthesiology and Pain Medicine

Abstract


Background: The aim of this study was to clarify the topographical relationship between the accessory nerve (AN) and transverse cervical artery (TCA) to provide safe and convenient injection points for AN blockade.

Methods: This study included 21 and 30 shoulders of 14 embalmed Korean adult cadavers and 15 patients, respectively, for dissection and ultrasound (US) examination.

Results: The courses of the TCA and AN in the scapular region were classified into four types based on their positional relationships. Type A indicated the nerve that was medial to the artery and ran parallel without changing its location (38%). In type B (38%), the nerve was lateral to the artery and ran parallel without changing its location. In type C (19%), the nerve or artery traversed each other only once during the whole course. In type D (5%), the nerve or artery traversed each other more than twice forming a twist. At the levels of lines I?IV, the nerve was relatively close to the artery (approximately 10 mm). TCAs were observed in all specimens around the superior angle of the scapula at the level of line II, whereas they were not found below line VI. In US images of the patients, the TCA was commonly observed at the level of line II (93.3%) where all ANs and TCAs were observed in cadaveric dissection.

Conclusions: The results expand the current knowledge of the relation between the AN and TCA, and provide helpful information for selective diagnostic nerve blocks in the scapular region.

키워드

Accessory Nerve; Diagnosis; Injections; Scapula; Scapular Region; Selective Nerve Blockade; Transverse Cervical Artery; Ultrasound
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