The infraclavicular block is quick to perform and provides a complete
block of the upper arm. Unlike the axillary approach, an infraclavicular
block can be performed without abduction of the arm. Complications and
contraindications are comparable to those for an axillary approach.
It is conducive to placement of the continuous catheter by being more accessible and more
comfortable for the patient than a catheter in the axilla.
The infraclavicular area can be
accessed by several approaches that permit flexibility, and
the use of ultrasound guidance is also possible. The clinical application of
this block has a short history and is continuing to evolve
with modifications of the technique. Infraclavicular blockade
is a useful alternative to the axillary approach and has the potential to be
more popular than axillary block in the near future.
Hirschel in 1911 is considered to have performed the first
percutaneous axillary block because he approached the plexus from the
axilla.1 His goal was to place the local anesthetic on top
of the first rib via the axilla. He discovered after his own dissections of
the plexus the reason for incompleteness of the axillary block and was the
first to describe that the axillary and musculocutaneous nerves separated
from the plexus much higher than in the axilla. However, the needles of the
day were not long enough to reach this area to block those
nerves.2 To remedy this problem in 1911, Kulenkampff's
supraclavicular description was soon to follow.2 He felt
his technique was safer and more accurate than Hirschel's, but after initial
success the reports of complications of pneumothorax ensued.
In 1914, Bazy3 described injecting below the clavicle just
medial to the coracoid process along a line connecting with Chassaignac's
tubercle. The needle trajectory was pointed away from the axilla, close to
the clavicle and was felt to present little chance of pleural damage. A
flurry of modifications came shortly after that during the next 8 years.
Babitszky4 proposed an entry site where the clavicle and
the second rib intersect, and Balog suggested actually impinging the second
rib. It is also during this time period (in the early 1900s) that volumes
were increased from the initial 5 mL to 20 mL. Also during this period an
increased success rate was noted with increased volume.
Knowledge of the anatomy was at the forefront in this period as well.
Babitszky said that “to discuss the anatomical relationship and the
technique more fully would be superfluous, as it is customary to familiarize
oneself with the anatomy of the field in question on the cadaver any time
one tends to use an unfamiliar technique.”2 The truth of
this statement is still valid today.
Labat in 1922 essentially redescribed Bazy's technique in his textbook,
Regional Anesthesia,5 as did Dogliotti6 in 1939. But the
technique seemed to fade into obscurity. The technique was not included in
Moore's Regional Block...