Infraclavicular Brachial Plexus Block

摘要

Patient Position: Supine Common Indication: Hand, wrist, elbow and distal arm surgery Equipment: A 10 cm long, short bevel, insulated stimulating needle; low output peripheral nerve stimulator. Volume: Forty to fifty ml of local anesthetic of choice: 3% chloroprocaine, 1.5% mepivacaine, 2% lidocaine, all with or without NaHCO3 and epinephrine. Ropivacaine 0.5% or bupivacaine are reserved for prolong procedures or postoperative analgesia. Anatomical landmarks: The bounderies of the infraclavicular fossa are pectoralis minor and major muscles anteriorly, ribs medially , clavicle and the coracoid process superiorly, and humerus laterally. With infraclavicular approach, brachial plexus is approached at the level of the cords in the infraclavicular fossa in proximity to the coracoid process. Technique: With the patient in the supine position, the block is best performed with the arm abducted at 90° angle and the patient’s head facing away from the arm to be anesthetized (Figure 1). The following anatomical landmarks are identified and marked: