Supraclavicular Block
The supraclavicular block targets the trunks and/or divisions of the brachial plexus. The location of the needle puncture is usually at the mid-point of the clavicle, just cephaloposterior to the subclavian artery.
The greatest fear when using this technique is the risk of pneumothorax as the cupula of the lung lies just medial to the first rib, not far from the plexus. The risk of pneumothorax is greater on the right side as the cupola of the lung is higher on that side.
Ultrasound imaging has increased the utilization of this block as one can visualize the subclavian artery, the first rib and the pleura and the block needle as it advances towards the plexus.
The supraclavicular block targets the trunks and/or divisions of the brachial plexus. The location of the needle puncture is usually at the mid-point of the clavicle, just cephaloposterior to the subclavian artery.
The greatest fear when using this technique is the risk of pneumothorax as the cupula of the lung lies just medial to the first rib, not far from the plexus. The risk of pneumothorax is greater on the right side as the cupola of the lung is higher on that side.
Ultrasound imaging has increased the utilization of this block as one can visualize the subclavian artery, the first rib and the pleura and the block needle as it advances towards the plexus.
Clinical Anatomy
The trunks of the brachial plexus (upper, middle and lower) course through the supraclavicular fossa and become divisions, after passing through the groove between the scalenus anterior and medius muscles (anterior and middle scalene muscles), above the first rib with the subclavian artery on the medial side. Immediately medial to the first rib, and about 1-2 cm from the posterior aspect of the plexus is the cupula (apex) of the lung.
The trunks of the brachial plexus (upper, middle and lower) course through the supraclavicular fossa and become divisions, after passing through the groove between the scalenus anterior and medius muscles (anterior and middle scalene muscles), above the first rib with the subclavian artery on the medial side. Immediately medial to the first rib, and about 1-2 cm from the posterior aspect of the plexus is the cupula (apex) of the lung.
Surface Anatomy
The patient is positioned supine with the head turned approximately 45º to the contralateral side. The needle insertion site is often at the midpoint of the clavicle with the conventional approach. The needle insertion site is often more lateral with the ultrasound-guided technique; a linear probe is often placed at the junction of the lateral third and medial two-thirds of the clavicle as the needle is moved towards the brachial plexus.
The patient is positioned supine with the head turned approximately 45º to the contralateral side. The needle insertion site is often at the midpoint of the clavicle with the conventional approach. The needle insertion site is often more lateral with the ultrasound-guided technique; a linear probe is often placed at the junction of the lateral third and medial two-thirds of the clavicle as the needle is moved towards the brachial plexus.
