Skip Navigation

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow E-Letters: Submit a response to the article
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (42)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Greher, M.
Right arrow Articles by Kapral, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Greher, M.
Right arrow Articles by Kapral, S.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

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{dagger}

M. Greher*,1, G. Retzl2, P. Niel3, L. Kamolz4, P. Marhofer1 and S. Kapral1

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

{dagger}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


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Contin Educ Anaesth Crit Care PainHome page
A. Macfarlane and K. Anderson
Infraclavicular brachial plexus blocks
CEACCP, October 1, 2009; 9(5): 139 - 143.
[Full Text] [PDF]

Home page
 Anesth. Analg.Home page
S. Renes, L. Clark, M. Gielen, H. Spoormans, J. Giele, and A. Wadhwa
A Simplified Approach to Vertical Infraclavicular Brachial Plexus Blockade Using Hand-Held Doppler
Anesth. Analg., March 1, 2008; 106(3): 1012 - 1014.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
V. Domingo-Triado, S. Selfa, F. Martinez, D. Sanchez-Contreras, M. Reche, J. Tecles, M. T. Crespo, J. M. Palanca, and B. Moro
Ultrasound Guidance for Lateral Midfemoral Sciatic Nerve Block: A Prospective, Comparative, Randomized Study
Anesth. Analg., May 1, 2007; 104(5): 1270 - 1274.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
E. Dingemans, S. R. Williams, G. Arcand, P. Chouinard, P. Harris, M. Ruel, and F. Girard
Neurostimulation in Ultrasound-Guided Infraclavicular Block: A Prospective Randomized Trial
Anesth. Analg., May 1, 2007; 104(5): 1275 - 1280.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
P. Bigeleisen and M. Wilson
A comparison of two techniques for ultrasound guided infraclavicular block
Br. J. Anaesth., April 1, 2006; 96(4): 502 - 507.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
O. Klaastad, O. Smedby, T. Kjelstrup, and H.-J. Smith
The Vertical Infraclavicular Brachial Plexus Block: A Simulation Study Using Magnetic Resonance Imaging
Anesth. Analg., July 1, 2005; 101(1): 273 - 278.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
N. M. Denny and W. Harrop-Griffiths
Editorial I: Location, location, location! Ultrasound imaging in regional anaesthesia
Br. J. Anaesth., January 1, 2005; 94(1): 1 - 3.
[Full Text] [PDF]

Home page
 Br J AnaesthHome page
P. Marhofer, M. Greher, and S. Kapral
Ultrasound guidance in regional anaesthesia
Br. J. Anaesth., January 1, 2005; 94(1): 7 - 17.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
S. Galloway and A. Bodenham
Ultrasound imaging of the axillary vein--anatomical basis for central venous access
Br. J. Anaesth., May 1, 2003; 90(5): 589 - 595.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
M. K. Peterson, F. A. Millar, and D. G. Sheppard
Editorial I: Ultrasound-guided nerve blocks
Br. J. Anaesth., May 1, 2002; 88(5): 621 - 624.
[Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.