Infraclavicular Block

    Level of difficulty: Intermediate

    Anatomy: Cords of the brachial plexus around the axillary artery below the clavicle

    Surface anatomy: Below the midpoint of the clavicle, deltopectoral groove

    Indications: Surgery of the elbow, forearm, and hand

    Nerves blocked: Lateral, posterior, and medial cords

    Positioning: Supine with arm abducted 90°

    Scanning technique: Parasagittal orientation inferior to the clavicle

    Structures to identify: Axillary artery, cords of brachial plexus

    Block performance: In-plane cephalad-to-caudad approach

    Position/Ergonomics: Operator at patient’s side

    Probe: High-frequency linear

    Settings: Nerve preset

    Depth: 3–5 cm

    Needle size: 80–100 mm

    Needling technique: In-plane cephalad-to-caudad

    Optimal needle tip position: Posterior to axillary artery within sheath

    Drug choice: 0.5% ropivacaine

    Volume: 20–30 ml

    Optimal current if NS used: 0.3–0.5 mA

    Muscle responses acceptable: Wrist/finger flexion or extension, biceps twitch

    Testing block success: Sensory block in median, ulnar, radial distributions

    Pearls: Useful for catheter placement and high success rates

    Side effects: Vascular puncture, incomplete block if cords not individually covered

    Complications: Pneumothorax (rare), nerve injury

    Continuous techniques:

    • Indication: Extended arm surgery or postoperative pain relief
    • Kit: Catheter-through-needle or catheter-over-needle
    • Catheter: 3–5 cm beyond needle tip
    • Regime: 5–10 ml/hr 0.2% ropivacaine

    Contraindications: Infection, bleeding disorder

    References: Bigeleisen PE. Anesth Analg. 2006