Infraclavicular plexus block

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The infraclavicular brachial plexus blockade , also known as the vertical infraclavicular brachial plexus blockade (VIB or VIP) or infraclavicular plexus anesthesia , is a regional anesthetic procedure that enables surgical interventions on the arm. The nerves of the brachial plexus ( median nerve , ulnar nerve , radial nerve , musculocutaneous nerve ) are reversibly blocked by injecting local anesthetics below ( infra- ) the collarbone ( clavicle ) . The infraclavicular brachial plexus blockade is a relatively simple procedure with few side effects. Advantages over axillary plexus block are a high rate of complete blockages and a fast attack time . The disadvantage is the risk of creating a pneumothorax as a complication .

application areas

The infraclavicular brachial plexus block allows operations on the lower (distal) upper arm, elbow, forearm and hand. It can also be used in pain therapy , for example in neuralgia , CRPS or phantom pain . During the puncture, a catheter is often inserted through which anesthetics can be continuously injected.

Contraindications are infections or tumors in the puncture area, blood clotting disorders or the use of anticoagulant drugs, foreign bodies ( pacemaker , ports ), pneumothorax , Horner's syndrome or recurrent palsy on the opposite side as well as rejection or lack of cooperation by the patient.

execution

Puncture site of the infraclavicular plexus block below the collarbone. Course of artery and nerves, location of elimination.

It is carried out under sterile conditions. The puncture site is located below the collarbone (see illustration). The puncture is made exactly in the center of the clavicle. According to the common technique according to Kilka , Geiger and Mehrkens , the cannula is inserted strictly vertically to the base, with the technique according to Raj the puncture is made outwards (lateral) towards the armpit. The identification of the nerves below the collarbone can be done in different ways. Usually the search is carried out with the help of a nerve stimulator, which is connected to the end of the puncture cannula. The position of the needle tip near the nerves is shown by muscle twitching in the hand area. Also, ultrasound-guided puncture is possible. More recent studies have shown it is superior to conventional technology.

When using the nerve stimulator, approximately 40 ml of local anesthetic is injected. In the case of ultrasound-targeted blockage, 10–15 ml of local anesthetic are sufficient for a sufficient blockage.

Depending on the duration of the operation, more rapid and short-acting local anesthetics such as prilocaine or mepivacaine or longer-acting substances such as ropivacaine are used, possibly also in combination.

Side effects

Side effects are rare. Nerve damage can be caused by direct cannula injury or by toxic effects of local anesthetics that are accidentally injected into the nerves ( intraneurally ). This damage can be avoided by using blunt cannulas and avoiding injections in case of paresthesia during the procedure. Accidental injection into blood vessels (intravascularly) can have effects on the cardiovascular system ( bradycardia , hypotension , cardiac arrest at high doses) or the central nervous system ( seizures , impaired consciousness ). The effects of local anesthetics can cause failure of the sympathetic cervical nerve cord ( Horner's syndrome ), the recurrent nerve ( recurrent palsy ) or, very rarely, the phrenic nerve ( phrenic nerve palsy ) , but these are reversible.

Puncturing the pleura ( pleura ) can result in a pneumothorax (0.2–0.7%).

Individual evidence

  1. ↑ SR Williams P. Chovinard, G. Arcand include: Ultrasound guidance speeds execution and Improves the quality of supraclavicular block. In: Anesth Analg. 97, 2003, pp. 1518-1523. PMID 14570678
  2. ↑ P. Marhofer, M. Greher, S. Kapral: Ultrasound guidance in regional anesthesia. In: Br J Anaesth. 94 (1), Jan 2005, pp. 7-17. Epub 2004 Jul 26th Review. PMID 15277302

literature

  • QH De Tran, A. Clemente, J. Doan, RJ Finlayson: Brachial plexus blocks: a review of approaches and techniques. In: Can J Anaesth. 54 (8), Aug 2007, pp. 662-674. Review. PMID 17666721
  • D. Jankovic: Regional blockades and infiltration therapy. 3. Edition. Abw Wissenschaftsverlag, 2003, ISBN 3-936072-16-7 , pp. 106-119.
  • G. Meier, J. Büttner: Compendium of peripheral blockades. 6th edition. Arcis-Verlag, 2008, ISBN 978-3-89075-177-1 .

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