ULTRASOUND-GUIDED INFRACLAVICULARÂ BRACHIAL PLEXUS BLOCK
Analgesia to the elbow and below
INDICATIONS
Blocks the brachial plexus at the level of the cords (medial, lateral, and posterior)
Indicated for arm, elbow, forearm, and hand surgery
Appropriate for when an axillary block is preferred but the patient is unable to abduct their arm for placement
Excellent analgesia for an arm tourniquet
CONTRAINDICATIONS
Absolute contraindications:
Patient refusal
Infection at injection site
Significant coagulation abnormalities
Relative contraindications:
Inability to cooperate during block placement or surgery
Preexisting neurologic disease
LANDMARKS
Clavicle
Coracoid process
Pectoralis major muscle
Pectoralis minor muscle
Axillary artery
SUPPLIES
Patient monitoring devices
Ultrasound equipment & a high-frequency linear transducer
Appropriately-sized sterile gloves
Local anesthetic for local infiltration with a small-gauge needle
Local anesthetic of choice and syringes
Echogenic needle
Lubricating jelly
Probe cover
Sterile skin cleansing solution
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*Always have emergency equipment/drugs available*
TECHNIQUE
Apply patient monitoring devices.
Position the patient supine. It is not necessary to adduct the arm but doing so may allow for easier identification of the axillary artery.
Don sterile gloves and cleanse the site with a sterile skin cleansing solution.
Place a sterile probe cover and lubricating jelly over the ultrasound probe.
Position the ultrasound probe just medial to the coracoid process and perpendicular to the clavicle.
Identify the pulsating axillary artery. The compressible axillary vein usually lies caudad to the artery.
Attempt to Identify the lateral, medial, and posterior cords of the brachial plexus.
The cords may not always be visualized.
Localize the skin.
​Needle passage through the pectoralis muscle is moderately painful, consider a short acting narcotic just before needle insertion.
Insert the needle in-plane from the cranial side and advanced caudad at a 30° angle posterior to the axillary artery.
The needle will pass through the pectoralis minor and pectoralis major muscle. This can be painful for the patient, consider a short-acting narcotic.
Injection of the 20-30 mL of local anesthetic to surround the artery in a U-shape pattern (cephalad, caudad, and posterior) will sufficiently block all 3 cords.
Avoid changing the pressure on the transducer at all times during injection to reduce the risk of intravascular injection.