V The brachial plexus is derived from the

cervical roots C5, C6, C7, C8 and the

thoracic root T1. The plexus runs from the
neck to the axilla passing between the
clavicle and the first rib. In the axilla the
plexus forms 3 cords which surround the
axillary artery - the posterior, lateral and
medial cords. The cords form the nerves to
the arm - the median, ulnar, radial and the
musculocutaneous nerve. Alongside the
axillary artery runs the axillary vein.
V Interscalene Brachial Plexus Block
V Supraclavicular(Subclavian)Brachial
Plexus Block
V Infraclavicular Brachial Plexus Block
V Axillary Brachial Plexus Block
V =orearm and hand surgery
V The patient is positioned supine with the head
turned 30 degree to the contralateral side.
V The interscalene groove is palpated at its most
inferior point which is just posterior to the
subclavian artery pulse, which can be felt just
medial to the midpoint of the clavicle.
V Another technique is just measure the whole
length of the clavicle and midpoint of the just
above the clavicle is the point one needs for
the supraclavicular approach.
V After a skin wheal with local anesthesia, a
22-guage ,1.5 inch needle is directed just
above and posterior to the subclavian Pulse
and directed caudally against the skin.
V The needle is advanced until a paresthesia
is encountered or muscle contraction of a
forearm is noted.
V If the paresthesia or contraction is still
observed ,then 25-40 ml of local anesthesia
is injected.
V If the rib is encountered without a
paresthesia or if blood is encountered, then
the needle is withdrawn and the landmarks
of the needle insertion path are re-
evaluated.
V Phrenic nv and recurrent laryngeal nv
blocked leading to respiratory failure
and Horner·s syndrome with dyspnea
and hoarseness of voice.
V Puncture of the pleura may cause
Pneumothorax.
V Hemothorax.
V Hematoma and Infection.
V Chylothorax