ULTRASOUND-GUIDED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK
Analgesia to the entire upper extremity distal to the shoulder
INDICATIONS
Blocks the brachial plexus at the level of the divisions.
Surgery for the upper extremity distal to the shoulder
CONTRAINDICATIONS
Absolute contraindications:
Patient refusal
Infection at injection site
Significant coagulation abnormalities
Relative contraindications:
The supraclavicular brachial plexus block should not be used bilaterally or in patients with respiratory compromise because of the potential risk of pneumothorax or phrenic nerve block
Inability to cooperate during block placement or surgery
Preexisting neurologic disease
LANDMARKS
Clavicle
Subclavian 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 and have the patient turn their head away from the side to be blocked.
Ask patient to reach for ipsilateral knee, will depress clavicle slightly & allow better access.
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.
Place the ultrasound probe on the clavicle and scan medially or laterally to identify the pulsating subclavian artery above the 1st rib.
The brachial plexus will be visualized superolateral to the subclavian artery as a cluster or hypoechoic oval structures.
Localize the skin.
Angle the needle just above the clavicle with a slight cephalad angle in a lateral to medial direction.
Insert the needle posterior to the plexus, in-plane until it is in close proximity to the roots of the brachial plexus.
Aspirate and inject while visualizing the spread of the local anesthetic.