Indications for Block


  • Shoulder Surgery (supplement supra scapular nerve block as may be missed
  • Brachial Neuritis (Trans-Trapezius Technique described by Dr. Rosenblum in video below)
  • Pain of the upper extremity distal to shoulder


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See below video and watch how Dr. Rosenblum uses the Trans-trapezius Suprasclavicular block to provide anesthesia for shoulder Bone Marrow Aspirate injection

Supraclavicular Brachial Plexus Block Video

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Subclavian Artery

The most important landmark

Insertion of the anterior scalene into the first rib lies between the vein (anteriorly) and the subclavian artery (posteriorly. On ultrasound the vein is well forward of the artery and is most of the time hidden below the clavicle.

Supraclavicular Region

Provides Anesthesia of the:

Arm, elbow, forearm, hand surgery, shoulder surgery

Brachial Plexus Anatomy

The Supraclavicular Brachial Plexus is ideal for analgesia of the shoulder and upper extremity. Provides reliable upper extremity anesthesia (distal to shoulder) to all of the Brachial Plexus.

Considerations

Locating the Brachial Plexus above the clavicle

  • Start from the supraclavicular space and look for the subclavian artery

  • Alternatively you can start in the neck in the anterior midline at the level of the thyroid gland and move laterally, identifying the carotid, internal jugular and then the anterior scalene and middle scalene, triangulating against the sternocleidomastoid muscle in the scan distal until you see the supraclavicular artery

  • A good place to end your search is where the nerves appear as a bunch of grapes around the artery

Advantages of the Supraclavicular Nerve Block

  • Reliable Block
  • Avoid phrenic nerve block and paralyzed ipsilateral hemidiaphragm (beneficial in patients with the compromised respiratory system such as COPD)
  • For procedures of the upper arm and elbow this block is a simple alternative to the axillary approach (even with ultrasound guidance) requiring fewer (if any) needle re-directions to complete the block.


Disadvantages

  • Risk of Pneumothorax (using classical Anesthesia Approach- Supine patient) 


Pain Office Applications

  • Brachial Neuritis
  • Anesthesia for other procedures (MSC into Shoulder)
  • CPT code 64415 76942 
  • Bupivicaine 0.125%-0.25%  2-5ml
  • Dexamethasone 2-4mg

Tips

  • The lung can be easily avoided by keeping control of the block needle and keeping it in the plane of the probe’s ultrasound beam at all times
  • Proceeding slowly allows you to place the needle on target accurately the first time
  • Once placed at the brachial plexus, slow injection usually insures effective distribution of the local anesthetic and there is usually no need to re-position the needle for further injection.

References

and Interesting Articles...

  • D'Souza RS, Johnson RL. Supraclavicular Block. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519056
  • Jeon DG, Kim WI. Cases series: ultrasound-guided supraclavicular block in 105 patients. Korean J Anesthesiol. 2010 Mar;58(3):267-71. doi: 10.4097/kjae.2010.58.3.267. Epub 2010 Mar 29. PMID: 20498776; PMCID: PMC2872833. Link
  • Tarıkçı Kılıç E, Akdemir M, S: Comparison of Supraclavicular, Infraclavicular, and Axillary Approaches for Ultrasound-Guided Brachial Plexus Block for Upper Limb Surgeries: A Retrospective Analysis of 182 Blocks. Dubai Med J 2018;1:33-37. doi: 10.1159/000496235


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