Supraclavicular plexus block

The supraclavicular plexus block is a regional anesthetic procedure that enables surgical interventions on the entire arm. The nerve cords (fascicles) of the brachial plexus (lateral fasciculus, posterior fasciculus, medial fasciculus) are reversibly blocked by injecting local anesthetics above (supra) the collarbone ( clavicle ) . The supraclavicular plexus block is a relatively simple procedure that has few side effects. Advantages compared to axillary blockade are a high rate of complete blockages and a fast attack time , compared to infraclavicular plexus blockade a lower risk of pneumothorax .

application areas

The supraclavicular plexus block allows operations on the upper arm (from the middle third), the elbow, the forearm and the hand. A pain therapy application is also possible. For this purpose, a catheter is placed as close as possible to the plexus, through which anesthetics can be administered continuously.

Contraindications (contraindications) are, as with all procedures regionalanästhesiologischen infections or tumors in the puncture area, Horner's syndrome or recurrent laryngeal nerve paralysis of the opposite side as well as rejection or lack of cooperation by the patient. Disorders of blood coagulation or taking anticoagulants are not an absolute contraindication for peripheral blocks (when using ultrasound-guided puncture techniques).

execution

It is carried out under sterile conditions. The puncture site is above the collarbone. The nerves at this point are usually identified by ultrasound control ; the puncture site is only about one to three centimeters distal to the interscalene blockade . The use of a nerve stimulator is also possible, but more recent studies have shown it to be 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 to 15 ml of local anesthetic are sufficient for sufficient blockage.

Side effects

Side effects can be direct nerve damage (toxic effects of local anesthetics or mechanical injury with the cannula). The use of blunt cannulas and the use of ultrasound significantly reduce this risk. 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.

Individual evidence

1. ^ Recommendations of the ÖGARI Perioperative Coagulation Working Group ; Regional anesthesia under anticoagulant medication
2. ↑ Guideline of the DGAI : thromboembolism prophylaxis with peripheral blockage techniques for regional anesthesia. In: Anästh. Intensivmed. 46 (2005), pp. 319-322.
3. ↑ 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
4. ↑ P. Marhofer, M. Greher, S. Kapral: Ultrasound guidance in regional anesthesia. In: Br J Anaesth. 94 (1), 2005 Jan, pp. 7-17. Review. PMID 15277302

literature

• P. Marhofer, M. Greher, S. Kapral; Ultrasound guidance in regional anesthesia. In: Br J Anaesth. 94 (1), 2005 Jan, pp. 7-17. Review. PMID 15277302

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