For shoulder and upper arm surgeries

BB is blocked between anterior and

middle scalene at level of Cricoid (C6)
Superior and middle trunks are blocked
Interscalene block
Sparing of inferior trunk or ulnar nerve
occurs
Anterior (Winnie’s) and posterior (pippas’s)
approaches

Also called as spinal anesthesia of upper extremities.

Supraclavicular block
OR complete block
Use in lower arm, elbow, forearm and hand surgeries
Distal trunk and proximal division of brachial plexus are
blocked
Done at caudal part of interscalene groove at its most
compact part above clavicle
Landmarks are clavicular head of SCM and inter-
scalene groove but the subclavian artery pulse is best
land mark for injection
Point the injection 1.5-2cm lateral to the clavicular head of
SCM and 2cm above clavicle
Approaching too much posterio-medialy can puncture the
dome of pleura and hence pneumothorax

Use for surgeries of hand,wrist, elbow and distal arm

BB is blocked either below mid point of clavicle
(classical approach) OR just medical to coracoid
(coracoid approach)
Infraclavicular block
Musculocutaneous and axillary nerves are blocked here
Blockade occurs at level of cords of musculocutaneous
and axillary nerves

Blockade occurs at level of terminal nerves

Complication like pneumothorax, phrenic block
and hornor syndrome can be avoided here
Musculocutaneous and intercostobronchial
nerves are spared this block isn’t suitable for
arm surgeries
Axillary block
Main disadvantage of this block is hematoma
formation and IV injections (systemic)
Instead of bupiviciane the lidocaine is best
Clonidine prolong the block