• M Neuburger, H Kaiser, B Ass, C Franke, and H Maurer.
• Abteilung für Anaesthesie, BG Unfallklinik Murnau. MichaelNeuburger@aol.com
• Anaesthesist. 2003 Jul 1; 52 (7): 619-24.

IntroductionThe vertical infraclavicular blockade of the brachial plexus (VIP) according to Kilka et al.is a technique which has gained more importance over the past years. This method distinguishes itself from other periclavicular techniques by a very low risk of pneumothorax (0.2%), which seems to be increased with asthenic patients.MethodsIn the study presented we examined 52 patients undergoing a vertical infraclavicular blockade of the brachial plexus, for an alternative method to determine the puncture point. With 31 of the 52 patients, who had a small distance (<20 cm) between the landmarks jugulum and anterior process of the acromion, the puncture point was moved 0.3 cm in a lateral direction for each centimeter less than 20 cm. Additionally we determined the "finger-point", i.e. the medial margin of the anesthetist's index finger, placed in the gap between the M. deltoideus and M. pectoralis with the finger tip touching the clavicle.ResultsIn 54% of the patients, the "finger-point" corresponded to the measured puncture point. In 46% of the patients, these points varied by a maximum of 1 cm in the lateral or medial direction. In 53% of the patients, the plexus could be found at the measured puncture point,which applied especially to the patients with a small distance between the leading points (<20 cm) and as a consequence a lateralized puncture point. If a correction of the puncture point was necessary to find the plexus, the correction by skin movement would always be in the direction of the "finger-point".ConclusionsAs a consequence, we assume that if the distance between the leading points jugulum and ventral process of acromion is smaller than 20 cm, the puncture point for a vertical infraclavicular blockade of the brachial plexus should be lateralized as described above; additionally, the "finger-point" should be determined in order to verify the puncture point and to finally give an idea of the direction, in case of a possible need for correcting the puncture point.

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