Background

The infraclavicular nerve block is a regional anesthesia technique to administered local anesthetic near the brachial plexus below the clavicle for transmission of nerve signals. 

The brachial plexus is a network of nerves from the cervical spinal cord to the arm. 

Clavicle, coracoid process, and axillary artery these are considered landmarks sites in infraclavicular block. 

In ultrasound guided technique various needle insertion options are available based on patient anatomy and optimal image quality. 

Space between anterior and middle scalene muscles holds trunks and it is divided in Lateral, Posterior and Medial cords. 

The brachial and antebrachial cutaneous nerves arise from medial cord. 

Cords are divided into nerve branches including musculocutaneous from the brachial plexus. 

Block is indicated for pain management in cases of trauma or chronic conditions that damage the upper limb. 

This block anesthetizes a large area of the arm as compared to axillary or supraclavicular blocks. 

The infraclavicular nerve block is used for surgical procedures on the arm, forearm, and hand.  

Indications

• Elbow Surgery 
• Forearm Surgery 
• Wrist/Hand Surgery 
• Pain Management 
• Trauma 
• Chronic Pain 
• It provides anesthesia and analgesia below the elbow. It is effective in bandage/patch pain, and it is not recommended for shoulder area. 

Contraindications

Absolute Contraindications are: 

• Patient Allergy 
• Infection at the Injection Site 
• Uncorrected Coagulation Disorders 

Relative Contraindications are: 

• Previous Surgery or Trauma in the Area 
• Severe Respiratory Conditions 
• Poor Anatomical Landmarks 

Outcomes

For surgical procedures the block should give adequate anesthesia to allow painless surgery. 

Patients may experience reduced postoperative pain to improved comfort and quicker recovery. 

This block can be used in combination with other analgesic techniques for enhanced pain management. 

With effective pain control, patients may have quicker functional recovery and return to normal activities. 

Compared to supraclavicular block this block has a lower risk of affecting the phrenic nerve. 

Equipment required

• Needles 
• Syringes 
• Ultrasound Machine 
• Nerve Stimulator 

Patient Preparation

Patient given anxiolytics and opioids before surgery if block is completed. A nasal cannula with oxygen is started with a nurse and the anaesthesiologist.  

All necessary equipment is available in good condition including local anesthetics, syringes, and needles. 

Assess the anatomical landmarks to check for any infections at the injection site. 

Patients should follow as instructed by the physician. Use a sterile needle and syringe to proceed the needle under ultrasound guidance.  

Informed Consent:  

Patients should understand procedure, benefits, risks, and alternatives for consent. 

Patient Positioning

Positioned the patient in supine/semi sitting position with the arm abducted at 45 degrees to expose the infraclavicular area. 

 Fig. clavicular pain  

Technique

Ultrasound-Guided Infraclavicular Block: 

• Step 1: Ultrasound Visualization
  Place the ultrasound probe transversely below the clavicle to see the brachial plexus and the axillary artery.  
• Step 2: Insertion of needle
  The needle is inserted just below the clavicle and the focus should be towards the brachial plexus.
  Insert the needle in perpendicular direction to adjust position under real-time ultrasound visualization. 
• Step 3: Administer Local Anesthetic Injection:
  Once the needle is in the correct position then check for blood return.
  Slowly inject the local anesthetic around the brachial plexus while observing on the ultrasound screen. 
• Step 4: Final Confirmation
  Make sure spread of the anesthesia around the brachial plexus to ensure no vascular structures are punctured. 

Nerve Stimulator-Guided Infraclavicular Block: 

• Step 1: Identification of the Plexus
   The brachial plexus is located near the axillary artery and the needle should be directed towards it. 
• Step 2: Insertion of needle
  Insert the needle perpendicular to the skin. The focus should be towards the brachial plexus with touch-and-feel technique to locate the nerve.
  Use a nerve stimulator to elicit muscle contractions to confirm proximity to the nerves. 
• Step 3: Administer Local Anesthetic Injection
  Once the needle is correctly positioned then aspirate to check for blood return, and finally inject the local anesthetic. 
• Step 4: Assessment of block 
  Assess the effectiveness of the block and check loss of sensation or motor function in the arm. 

Complications

Common complications are: 

Incomplete Block: 

• Partial or inadequate anesthesia of the arm may not be fully anesthetized. 

Hematoma: 

• Bleeding at the injection site can cause hematoma. 

Pneumothorax: 

• Accidental puncture of the lung causes a collapsed lung. 

Nerve Injury: 

• Direct trauma to the nerves causes temporary/permanent sensory and motor injury 

Vascular puncture: 

• Accidental puncture of the axillary artery or vein. 
• Infection 
• Phrenic Nerve Blockade 
• Systemic Toxicity 
• Intravascular/intraneural injection 

Local Anesthetic Systemic Toxicity 

References

Infraclavicular Nerve Block – StatPearls – NCBI Bookshelf (nih.gov) 

References

Infraclavicular Nerve Block – StatPearls – NCBI Bookshelf (nih.gov)