Interscalene approach to brachial plexus block does not provide optimal surgical anaesthesia in the area of distribution of which of the following nerve?
**Core Concept**
The interscalene approach to brachial plexus block is a regional anesthesia technique used to provide surgical anesthesia to the upper limb. It involves the injection of local anesthetic around the brachial plexus, which is a complex network of nerves that arises from the spinal cord and supplies the arm and hand. The interscalene approach targets the nerves of the upper trunk of the brachial plexus.
**Why the Correct Answer is Right**
The interscalene approach is less effective in providing anesthesia to the area of distribution of the **ulnar nerve**. This is because the ulnar nerve arises from the lower trunk of the brachial plexus, which is not adequately targeted by the interscalene approach. The ulnar nerve provides motor and sensory innervation to the forearm and hand, particularly the little finger and ring finger.
* **Option A:** The musculocutaneous nerve is targeted by the interscalene approach, providing anesthesia to the area of distribution of the biceps brachii muscle and the skin of the lateral forearm. **This distractor is incorrect because the musculocutaneous nerve is not the primary concern for the interscalene approach.**
* **Option B:** The axillary nerve is not targeted by the interscalene approach, providing anesthesia to the area of distribution of the deltoid muscle and the skin overlying the shoulder. **This distractor is incorrect because the axillary nerve is not the primary concern for the interscalene approach.**
* **Option C:** The radial nerve is targeted by the interscalene approach, providing anesthesia to the area of distribution of the extensor muscles of the forearm and the skin of the back of the hand. **This distractor is incorrect because the radial nerve is not the nerve that is inadequately targeted by the interscalene approach.**
**Clinical Pearl / High-Yield Fact**
When performing an interscalene block, it is essential to ensure that the local anesthetic is deposited at the correct level to avoid inadequate anesthesia to the ulnar nerve distribution. This can be achieved by using ultrasound guidance to visualize the spread of the anesthetic and by using a high concentration of local anesthetic.
**Correct Answer:** C.