Infraclavicular vertical brachial plexus block
Problems that may arise with the axillary plexus block, such as incomplete dissemination of the anaesthesia (radial and musculocutaneous nerves), pain resulting from an Esmarch upper-arm tourniquet, as well as positioning difficulties (fractures, rheumatic patients) prompted us to look for an alternative means of access to the brachial plexus. The infraclavicular vertical brachial plexus block (VIP) was determined to be a procedure that is safe and low-risk, easy on the patient and simple for the anaesthesiologist to perform.
Ultrasound-guided infraclavicular nerve block
In contrast to the above-described vertical infraclavicular block, it has proven helpful to position the patient‘s arm at about a 90° angle before carrying out an ultrasound-guided puncture in this region, since this improves visualization of the plexus. It should also be mentioned, however, that exact visualization of the parts of the plexus is much easier from a supraclavicular direction, even though the anatomic distance between the two sites is only a short one. To be named among the anatomic landmarks, in addition to the major and minor pectoral muscles, are the subclavian artery and vein. The brachial plexus lies against the artery on its cranial side. Finally, the bony thorax and the pleural cavity are also distinguishable.