Brachial plexus blockade is routinously performed by using the axillary route. From clinical experience and anatomical point of view it is known that the axillary approach is not the ideal technique to achieve efficient brachial plexus anesthesia. Regarding the anatomical conditions, it is clear that the mid-retrosubclavian region should be the most appropriate place to apply the local anesthetic agent due to the fact that all three fascicles of the plexus are lying close together. During the past several decades different supra- and infraclavicular approaches have been described but none of them are still in use to a great extent today. Since 1993 we routinely have used the vertical infraclavicular approach, a self developed technique based on detailed anatomic studies. This method of brachial plexus blockade has clearly defined guidelines using simple reproducible landmarks and is performed by applying a strongly vertical puncture at the center line between the ventral apophysis of acromion (lateral landmark) and the jugular notch (medial landmark) directly beneath the clavicula. The patient is lying in a supine position with his forearm relaxed on the chest and his head slightly turned to the contralateral side. The brachial plexus is met in 3 to 4 cm depth. Because of its advantages the vertical infraclavicular blockade has become the most applied technique in upper extremity regional anesthesia in our hospital. The method has a high success rate, low risks, and a high acceptance by both patients and anesthetists. © 2003 Elsevier Inc. All rights reserved.
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