[Brachial plexus block. The anaesthetic line is a guide for new approaches]

Brachial plexus blockade is one of the most widespread technique in regional anaesthesia. Many Authors presented different approaches to the plexus, following different routes, over or under the clavicle related to near landmarks, paresthesia or electrical nerve stimulation. The Author presents an anatomical perspective to guide the localization of the brachial plexus, following an anaesthetic line created by linking together several landmarks, generally used in few number for single approach techniques, over or under the clavicle. The line leaves from the apex of the scalene triangle, through the middle point of the clavicle, the middle point between the coracoid process and the chest profile, and arrives to the pulsation of the axillary artery, when the arm is abducted at 45 degrees. This general view favours a better understanding of the placement of the brachial plexus, following the anatomical guide developed from the anaesthetic line; thus the placement of the needle, from distal to proximal, in a vertical or tangential route towards the nerve structures becomes clearer, showing the different entry point in a simple and efficacious way. The same technique may apply to the infraclavicular approach, favouring the vertical approach or a tangential one, when catheterisation is needed.