Supraclavicular Block - TOP

Brandon Michael Togioka, M.D.
Resident Physician

Christopher L Wu, M.D.
Professor

Department of Anesthesiology and Critical Care Medicine
Johns Hopkins School of Medicine
Baltimore, MD

Introduction - TOP

Regional anesthesia for upper extremity surgery has many advantages over traditional general anesthesia with systemic opioids.  Among these advantages are more effective postoperative analgesia, decreased requirements for systemic opioids and the potential complications associated with their use, and an ability to avoid instrumenting the airway.1  If performed by experienced operators it can provide successful surgical anesthesia in a high majority of cases (94.2-94.7%) with a very low complication rate.2-4

The supraclavicular block, first described by Kulenkampf, provides a consistent homogenous blockade of the entire upper extremity without preferentially sparing the cephalad (musculocutaneous) or caudad (ulnar) nerves of the brachial plexus.5  The popularity of the supraclavicular approach to block the brachial plexus substantially increased with the introduction of ultrasound technology as it greatly reduced the incidence of pneumothorax.  Prior to the introduction of ultrasound the pneumothorax rate was reported between 0.6% and 5%.6  This rate is now very close to zero as evidenced by the lack of any reported pneumothoracies in four publications with a combined patient population of 2,590.2,4,6,7  Thus, the ultrasound-guided supraclavicular block will be described below. 

It should be noted that some clinicians prefer to use nerve stimulation as an adjunct to ultrasound-guided nerve blockade.  This technique has been shown to have limited utility.8  Positive motor response to nerve stimulation has not been shown to increase the success rate of a block and in one study 90% of patients without a motor response still had a successful block, which was defined as one that sufficed as sole anesthetic.8

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