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Continuing Education in Anaesthesia, Critical Care & Pain Advance Access originally published online on September 2, 2009
Continuing Education in Anaesthesia, Critical Care & Pain 2009 9(5):139-143; doi:10.1093/bjaceaccp/mkp024
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© The Author [2009]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Infraclavicular brachial plexus blocks

Alan Macfarlane, BSc MBChB MRCP FRCA
Specialist Registrar
Glasgow Royal Infirmary
Glasgow
UK

Keith Anderson, BSc MBChB FRCA
Consultant Anaesthetist
Glasgow Royal Infirmary
10 Alexandra Parade
Glasgow G31 2ER
UK
Tel: +44 141 211 4620
Fax: +44 141 211 1191
E-mail: keithanderson@doctors.net.uk (for correspondence)

The first 150 words of the full text of this article appear below.


Key points

The vertical infraclavicular block (ICB) has a high success rate from single injection using a nerve stimulator, but has potentially serious complications such as phrenic nerve palsy (25%) and pneumothorax (0.7%).
Pericoracoid ICBs require multiple injections with a nerve stimulator or ultrasound guidance to verify adequate local anaesthetic spread posterior to the axillary artery to be successful.
ICBs may take 30 min before surgery can commence.
They are useful if the arm is immobile, often provide good anaesthesia of the upper arm (especially vertical infraclavicular), and provide an ideal site for catheter fixation for local anaesthetic infusions.

 


   Anatomy and sites for blocks
 
Successful brachial plexus block requires a thorough knowledge of anatomy, both to decide on the appropriate approach and to locate the nerves. The plexus is traditionally found at specific anatomical points by using bony or vascular landmarks, whereas ultrasound allows block of the plexus at any point along its length. The . . . [Full Text of this Article]


   Infraclavicular approaches to the brachial plexus
 
Medial approaches around the middle of the clavicle

Lateral approaches around the coracoid process

Pericoracoid ICB5

Parasagittal ICB6


   Drug dose/volume and plexus localization
 
Nerve stimulation and the optimum response

Ultrasound

Technique


   Choosing the best infraclavicular approach
 

   Clinical characteristics of supraclavicular and axillary blocks
 
Supraclavicular

Advantages

Disadvantages

Axillary block

Advantages

Disadvantages


   Clinical niche for ICBs
 

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