Anatomische Landmarken für periphere Nervenblöcke an Unterarm und Handgelenk: Eine Untersuchung an Leichenpräparaten

Zusammenfassung

Hintergrund Es gibt keine Daten, die eine standardisierte, auf Orientierungspunkten basierende Technik zur Blockierung sensibler Nerven des Unterarms gewährleisten.

Ziel Ziel dieser Untersuchung war es, Stellen an Unterarm und Ellenbogen zu definieren, an denen unter Orientierung an gut tastbaren knöchernen Landmarken Nervenblockaden relativ sicher erfolgreich möglich sind.

Methoden An fünf Leichenarmen wurden der Ramus superficialis des N. radialis (RSNR), der dorsale Ast des N. ulnaris (RDNU), der laterale, mediale und dorsale N. cutaneus antebrachii (NCAL, NCAM, NCAD) sowie der Ramus palmaris des N. medianus (RPNM) präpariert. In Bezug auf den Processus styloideus radii und ulnaris, das Listerʼsche Tuberkulum sowie den Epikondylus medialis und lateralis sowie Verbindungslinien zwischen diesen gut tastbaren Knochenvorsprüngen wurden Stellen lokalisiert, an denen die vorgenannten Nerven aufzufinden und zu blockieren sind.

Ergebnisse Die Nerven können an folgenden Stellen sicher blockiert werden: der RSNR 85 mm proximal des Listerʼschen Tuberkels auf einer Linie zwischen letzterem und dem Epicondylus humeri medialis; der NCAL 38 mm und der NCAD 32 mm ulnar vom Epicondylus humeri lateralis; der NCAM 14 mm radial zum medialen Epicondylus; der RDNU 27 mm proximal zum Ulnastyloid in Richtung des lateralen Epicondylus; der RPNM auf einer nach ulnar zielenden Senkrechten zur Verbindungslinie zwischen dem Processus styloideus radii (PSR) und dem medialen Epikondylus 45 mm proximal des PSR und 21 mm nach ulnar.

Schlussfolgerung Unter Verwendung gut tastbarer Knochenvorsprünge am distalen Unterarm und Ellenbogen und Verbindungslinien zwischen ihnen lassen sich der RSNR, RDNU, RPNM sowie die NNCAL/M und D sicher lokalisieren.

Evidenzgrad IV

Abstract

Background There are no data ensuring a standardized landmark-based-technique for blocking sensitive nerves of the forearm.

Purpose To identify locations were with use of good palpable bony landmarks and lines between them sensitive nerve blocks on the forearm can be done with great success.

Material and Methods Dissection of the superficial branch of the radial nerve (SBRN), the dorsal branch of the ulnar nerve (DBUN), the lateral, medial and dorsal antebrachial cutaneous nerve (LACN, MACN, and DACN) as well as the palmar branch of the median nerve (PBMN) was performed on five upper limbs of five different Caucasian cadavers. With respect to radius and ulnar styloid, Lister’s tubercle, and the medial and lateral epicondyle of the humerus as well as connecting lines between these bony landmarks locations were defined, where the mentioned nerves can be found and blocked.

Results The six nerves can be safely blocked at the following sites: the SBRN 85 mm proximal to Lister’s tubercle on a line drawn between the latter and the medial humeral epicondyle; the LACN 38 mm and the dorsal one 32 mm ulnar from the lateral epicondyle; the MACN 14 mm radial to the medial epicondyle; the DBUN 27 mm proximal to the ulnar styloid in direction to the lateral epicondyle; the PBMN 45 mm proximal to the radial styloid following a line between the latter and the medial epicondyle and 21 mm ulnarwards perpendicular to this line.

Conclusion Using superficial good palpable landmarks at the wrist and elbow as well as connecting lines between them the SBRN, DBUN, PBMN, LACN, MACN, and DACN can easily be located.

Schlüsselwörter

Periphere Nervenblockaden - Ramus superficialis Nervus radialis - Ramus dorsalis Nervus ulnaris - Ramus palmaris Nervus medianus - Nervus cutaneous antebrachii lateralis - medialis - dorsalis

Key words

Peripheral nerve blocks - superficial branch of the radial nerve - dorsal branch of the ulnar nerve - palmar branche of the median nerve - lateral - medial and dorsal antebrachial cutaneous nerve

Publikationsverlauf

Eingereicht: 30. Juni 2020

Angenommen: 07. Januar 2021

Artikel online veröffentlicht:
15. Februar 2021

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