Infraclavicular Nerve Block

Anatomy

Level of cords of Brachial Plexus Lateral, Medial and Posterior (named according to relation to Axillary Artery)

Vertical Approach Vertical Mid-point between anterior process on acromion and jugular notch (below clavicle) Below the clavicle and lateral to subclavian artery Pass needle in HORIZONTAL PLANE ONLY --.NO MEDIAL ANGULATION Can be less than 2cm deep in thin patients Note ± lung may be less than 5m deep also .

Subcoracoid Approach Subcoracoid Identify coracoid process Mark a point 2cm inferior and 1-2cm medial Pass needle in SAGITTAL PLANE ONLY --.NO MEDIAL ANGULATION Depth = 3±8 cm Distances and depth may need proportional adjustment in smaller patients .

Thumb adduction (if surgery in ulnar distribution ± medial cord) Don¶t Accept : Pectoral twitch (too superficial or medial) Elbow flexion (lateral cord = too superficial or cephalad) Posterior scapula movements (too deep.Motor responses Vertical Approach Wrist / Finger Extension (posterior cord) Don¶t Accept: Pectoral twitch (too superficial or medial) Elbow flexion (lateral cord = too superficial or lateral) No twitch (too lateral) Subcoracoid Approach Wrist / Finger Extension (posterior cord) Wrist flexion. outside plexus) .

wrist. Skin of the axilla and proximal medial armis NOT blocked (intercosobrachial and medium cutaneousbrachii nerves). Nerves blocked Chest ± Anterior thoracic Shoulder ± Subscapular and Axillary Arm. forearm and hand Musculocutaneous Internal cutaneous Lesser internal cutaneous Median Ulnar Radial (musculospiral) . forearm. and distal arm.Area Anaesthetised Typical block includes hand. elbow.

Pitfalls and Complications Vertical Approach Side-effects Rarely laryngeal Nerve Block or Stellate Ganglion Block Complications Vascular puncture Inadvertent intravascular injection Pneumothorax 1:1000 Subcoracoid Approach Side-effects Nil of note Complications Vascular puncture Inadvertent intravascular injection .

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