title: [Vertical infraclavicular blockade of the brachial plexus (VIP). A modified method to verify the puncture point under consideration of the risk of pneumothorax].
abstract: BACKGROUND
  The 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.
  
  
  METHODS
  In 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.
  
  
  RESULTS
  In 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".
  
  
  CONCLUSIONS
  As 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.
authors.affiliation: Abteilung für Anaesthesie, BG Unfallklinik Murnau. MichaelNeuburger@aol.com
authors.forename: M
authors.initials: M
authors.lastname: Neuburger
authors.forename: H
authors.initials: H
authors.lastname: Kaiser
authors.forename: B
authors.initials: B
authors.lastname: Ass
authors.forename: C
authors.initials: C
authors.lastname: Franke
authors.forename: H
authors.initials: H
authors.lastname: Maurer
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000886:Anthropometry; D001247:Asthenia / Q000150:complications; D001917:Brachial Plexus / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D011030:Pneumothorax / Q000453:epidemiology