British Journal of Anaesthesia, 2002, Vol. 88, No. 5 632-636
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia
Clinical Investigations |
Ultrasonographic assessment of topographic anatomy in volunteers suggests a modification of the infraclavicular vertical brachial plexus block
1Department of Anaesthesia and General Intensive Care, University Hospital of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. 2Institute of Anatomy, Department 3, University of Vienna, Waehringerstrasse 13, A-1090 Vienna, Austria. 3Department of Medical Statistics, University of Vienna, Schwarzspanierstrasse 17, A-1090 Vienna, Austria. 4Department of Plastic and Reconstructive Surgery, University Hospital of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria*Corresponding author
This article is accompanied by Editorial I.
Background. The infraclavicular vertical brachial plexus block, first described by Kilka and co-workers, offers a more proximal spread of anaesthesia for the upper extremity than the classic axillary approach. In this technique, the puncture site is defined as lying at the exact centre of an infraclavicular line (k) between the jugular fossa and the ventral process of the acromion. Our study was designed to determine whether the point so defined (P) corresponds with the optimal puncture site determined sonographically (S) and to develop an improved prediction model.
Method. High-resolution ultrasonography was carried out in 59 volunteers to visualize the plexus. Sonography-derived distances and morphometric measurements were used to test accuracy and calculate multiple regressions.
Results. We found a clear trend towards a more lateral puncture site. In women, S was significantly (P<0.001) lateral (8 mm) to P. The overall accuracy of the infraclavicular vertical brachial plexus block technique was not sufficient to predict the optimal puncture site reliably. Our resulting improved prediction model is valid for both sexes and is based not just on the centre point but on the absolute length of k (22–22.5 cm). We found that for every 1 cm decrease in k the optimal puncture site moved 2 mm laterally from the exact centre of k, and for every 1 cm increase in k it moved 2 mm medially.
Conclusions. The suggested modification should help to increase the success rate of the infraclavicular vertical brachial plexus block while decreasing the rate of potentially severe complications, although individual ultrasonographic guidance is to be recommended whenever possible.
Br J Anaesth 2002; 88: 632–6
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