![]() The subclavian vein (SCV) accompanies the BP and SCA as it travels towards the root of the neck. The SCA lies anteromedial to the BP whereas both the latter two structures pass laterally and posterior to the anterior scalene muscle. The supraclavicular block is performed where the BP passes between the anterior and middle scalene muscles and follows the subclavian artery (SCA) into the arm between the clavicle and the first rib. Other contraindications that may arise include infection at the site of injection, the inability to insert the needle at the injection site due to a splint or cast that may be present or allergies to local anaesthetics. Relative and absolute contraindications must be considered prior to its utilisation and may include pre-existing neuropathies or nerve injury and severe coagulopathies or anticoagulants. 2, 3 Furthermore, it provides analgesia to the upper extremity for post-surgical and traumatic pain, complex regional pain syndrome, post-amputation pain, vascular diseases and tumour-related pain. 2, 3 Fractures, dislocations and abscesses, as well as general surgery of the upper extremity for both adults and children, are examples of common indications for this block. The supraclavicular block is indicated for provision of an anaesthetic block for surgery or intra- and postoperative pain control for the entire upper limb including the shoulder, arm, elbow, forearm and the hand. However, intravascular injection is more common in this approach compared with other approaches. Complications that may occur are specific to each terminal nerve. The axillary brachial plexus block is performed at the level of the terminal branches of the BP and may require multiple injections. Complications that can occur include chylothorax, which is a rare complication that occurs when performing left-sided blocks, and pneumothorax, which occurs more frequently as compared with the supraclavicular approach. This approach is often used for the placement of indwelling catheters as the infraclavicular site provides stable positioning. The infraclavicular approach targets the cords of the BP and is indicated for surgery of the distal arm, elbow, forearm and hand. The most common complications for this approach include hemi-diaphragmatic paralysis and Horner’s syndrome, which are directly related to the volume of local anaesthetic used. Therefore, this approach is not recommended for surgery of the forearm or hand. Although this groove is easy to locate, the local anaesthetic does not sufficiently anaesthetise the inferior trunk. The interscalene BP block, which is indicated for surgery of the shoulder region, clavicular area, arm and elbow joint, is performed in the interscalene groove. 2Īlternative approaches include the interscalene, infraclavicular and axillary BP nerve blocks. 1 According to the literature, the supraclavicular approach proves to be one of the safest and most effective techniques. The supraclavicular block also has the most widespread extent of sensory blockade among all the BP approaches and is ideal for providing dense, rapid onset, and efficient anaesthesia and analgesia for procedures from the shoulder joint and mid-humerus proximally, to the hand distally. ![]() 1 Due to the limited surface area, the entire BP is anaesthetised. ![]() #Complete anatomy brachial plexus skin#1 With this approach, the trunks/divisions of the BP are compact and superficial to the skin making it easy to visualise on ultrasound. The supraclavicular approach to the brachial plexus block was first described in the early twentieth century and is arguably the most preferred brachial plexus (BP) approach with the highest success rate. ![]()
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