INFRACLAVICULAR BRACHIAL-PLEXUS BLOCK - PARASAGITTAL ANATOMY IMPORTANT TO THE CORACOID TECHNIQUE

Infraclavicular brachial plexus block is a technique well suited to pr olonged continuous catheter use. We used a coracoid approach to this b lock to create an easily understood technique. We reviewed the magneti c resonance images of the brachial plexus from 20 male and 20 female p atients. Using scout films, the parasagittal section 2 cm medial to th e coracoid process was identified. Along this oblique section, we loca ted a point approximately 2 cm caudad to the coracoid process on the s kin of the anterior chest wall. From this point, we determined simulat ed needle direction to contact the neurovascular bundle and measured d epth. At the skin entry site, the direct posterior insertion of a need le will make contact with the cords of the brachial plexus where they surround the second part of the axillary artery in all images. The mea n (range) distance (depth along the needle shaft) from the skin to the anterior wall of the axillary artery was 4.24 +/- 1.49 cm (2.25-7.75 cm) in men and 4.01 +/- 1.29 cm (2.25-6.5 cm) in women. Hopefully, thi s study will facilitate the use of this block. Implications: We sought a consistent, palpable landmark for facilitation of the infraclavicul ar brachial plexus block. We used magnetic resonance images of the bra chial plexus to determine the depth and needle orientation needed to c ontact the brachial plexus. Hopefully, this study will facilitate the use of this block.