3.8 Infraclavicular Brachial Plexus Block

Question 1

Midclavicular Brachial plexus block

Answer 1

SLIMRAG

Line drawn + measured between Jugular Notch and Ventral acromion

Mid approach:
Midpoint of line
puncture site

(move laterally .3cm for every cm >20cm)

Question 2

Midclavicular Brachial plexus block

Answer 2

50mm nerve stim needle
Inserted vertically
advance sagittal plane
Ventral to Dorsal

Care to avoid medial angulation
Pleura lies in close proximity
(Inferomedially)

Cords identified ~ 3cm
Needle not advanced beyond 4

Negative aspiration
injection

US infraclav
Focus around coracoid process
easier to visualise needle and anatomy

Question 3

Cord Identification

Answer 3

Posterior
Wrist / Finger extension
best results

Question 4

Medial cord

Answer 4

Wrist flexion
thumb adduction

Accept if surgey in ulnar territory
A/W medial needle position
May need lateral adjustment

Question 5

Lateral Cord

Answer 5

Elbow flexion - Musculucut
Do not accept
too lateral and superficial

Musculo + Axillary nerve
leave plexus sheath before coracoid in 50%

Question 6

Subscapular

Answer 6

Posterior adduction of scapula
Reject
outside sheath

Question 7

Complications

Answer 7

PTX

IV injection

Intraneural / intrafascicular injection

Pec haematoma

Failure