[Biometric data on risk of pneumothorax from vertical infraclavicular brachial plexus block. A magnetic resonance imaging study].
In the present study 48 sagittal and transversal magnetic resonance images of volunteers were examined for biometric data concerning risk of pneumothorax at the vertical infraclavicular blockade (VIP) of the brachial plexus. With a correct puncture the plexus can be reached after 3 cm. The shortest way to the lung is 5.3 cm (3.1-8.7 cm) at a incorrect medial angle of puncture of 46.3 degrees (35-58 degrees). While moving the angle of puncture at a minimum of 24.1 degrees (1-51 degrees) in a medial direction, a depth of 6.1 cm (4-8.9 cm) has to be reached for fatal lung puncture. The puncture point has to be determined 2.8 cm (0-4.1 cm) towards the midline of the body to have a pleura connection by a strictly vertical puncture at 6 cm (4-8.9 cm). In asthenic women, shorter distances were obtained. A considerable lower deviation can lead to pleural damage (7.5 degrees; 4.7 cm). The plexus is very close to the skin surface (1.6-3 cm). In one case, the risk for pneumothorax could be measured even with the correct puncture technique. Overall, the VIP is a very safe method for brachial plexus anaesthesia with regard to the risk of pneumothorax. In asthenic women, the risk seems to be higher but can be minimised by reducing the maximum puncture depth.
Neuburger
M
M
Anaesthesiologische Klinik, Universitätsklinikum Freiburg. MichaelNeuburger@aol.com
Kaiser
H
H
Uhl
M
M
D001917:Brachial Plexus / Q000033:anatomy & histology; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology*; D055370:Lung Injury; D008279:Magnetic Resonance Imaging; D019148:Neuromuscular Blockade; D011030:Pneumothorax / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology*; D018570:Risk Assessment