infraclavicular block
TRANSCRIPT
![Page 1: Infraclavicular Block](https://reader033.vdocuments.site/reader033/viewer/2022061120/546cfd7ab4af9fb57f8b46e6/html5/thumbnails/1.jpg)
Infraclavicular Nerve Block
Level of cords of Brachial Plexus
Lateral, Medial and Posterior (named according to relation to Axillary Artery)
Anatomy
![Page 2: Infraclavicular Block](https://reader033.vdocuments.site/reader033/viewer/2022061120/546cfd7ab4af9fb57f8b46e6/html5/thumbnails/2.jpg)
Vertical ApproachVertical
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
![Page 3: Infraclavicular Block](https://reader033.vdocuments.site/reader033/viewer/2022061120/546cfd7ab4af9fb57f8b46e6/html5/thumbnails/3.jpg)
Subcoracoid ApproachSubcoracoid
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
![Page 4: Infraclavicular Block](https://reader033.vdocuments.site/reader033/viewer/2022061120/546cfd7ab4af9fb57f8b46e6/html5/thumbnails/4.jpg)
Motor responsesVertical 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 ApproachWrist / Finger Extension (posterior cord)
Wrist flexion, 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, outside plexus)
![Page 5: Infraclavicular Block](https://reader033.vdocuments.site/reader033/viewer/2022061120/546cfd7ab4af9fb57f8b46e6/html5/thumbnails/5.jpg)
Area AnaesthetisedTypical block includes hand, wrist, forearm, elbow, and distal arm.
Skin of the axilla and proximal medial arm is NOT blocked (intercosobrachial and medium cutaneous brachii nerves).
Nerves blockedChest – Anterior thoracic
Shoulder – Subscapular and Axillary
Arm, forearm and hand Musculocutaneous
Internal cutaneous
Lesser internal cutaneous
Median
Ulnar
Radial (musculospiral)
![Page 6: Infraclavicular Block](https://reader033.vdocuments.site/reader033/viewer/2022061120/546cfd7ab4af9fb57f8b46e6/html5/thumbnails/6.jpg)
Pitfalls and Complications
Vertical ApproachSide-effects
Rarely laryngeal Nerve Block or Stellate Ganglion Block
ComplicationsVascular puncture
Inadvertent intravascular injection
Pneumothorax 1:1000
Subcoracoid ApproachSide-effects
Nil of note
ComplicationsVascular puncture
Inadvertent intravascular injection