Letters to the Editor
Vol. 4 No. 1 (2026)
Anatomical variation of the brachial plexus roots identified during pre-procedural ultrasound for an interscalene block
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 2 February 2026
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Authors
Dear Editor,
In shoulder surgery, the interscalene brachial plexus block (ISB) remains the most frequently employed technique. At this level, the brachial plexus roots are known to display several anatomical variations. In this letter, we report an anatomical variant of the brachial plexus roots observed during an ultrasound scan prior to performing an ISB. We illustrate the observed sono-anatomy features of the variant seen, offer an explanation as to why targeting this variant may clinically result in a failed block, and describe a rescue strategy. [...]
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Citations
1. Feigl GC, Litz RJ, Marhofer P. Anatomy of the brachial plexus and its implications for daily clinical practice: regional anesthesia is applied anatomy. Reg Anesth Pain Med 2020;45:620-7. DOI: https://doi.org/10.1136/rapm-2020-101435
2. Nadeau MJ, Lévesque S, Dion N. Ultrasound-guided regional anesthesia for upper limb surgery. Can J Anaesth 2013;60:304-20. DOI: https://doi.org/10.1007/s12630-012-9874-6
3. Keet K, Louw G. Variation of the brachial plexus roots in the interscalene groove: relevance in interscalene blocks. Anatomy (Istanbul) 2019;13:40-8. DOI: https://doi.org/10.2399/ana.19.030
4. Kılıçaslan A, Gök F, Korucu İH, et al. Anatomical variations detected during ultrasound-guided interscalene brachial plexus block and clinical implications. Marmara Med J 2020;33:221-6. DOI: https://doi.org/10.5472/marumj.816311
How to Cite
Anatomical variation of the brachial plexus roots identified during pre-procedural ultrasound for an interscalene block. (2026). Advances in Anesthesia and Pain Medicine, 4(1). https://doi.org/10.4081/aapm.2026.60
Copyright (c) 2026 Federico Tamburi, Giorgio Ranieri, Aneurin Moorthy
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
