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Chapter 31D. Ultrasound-Guided Infraclavicular Brachial Plexus Block

Compared to other brachial plexus nerve blockade approaches, the infraclavicular approach:

A. Has an increased risk of respiratory complaints by the patient if performed correctly without complications

B. Is ideal for placement of a continuous infusion catheter due to the relative depth of the plexus at this level

C. Is well suited for shoulder surgery as the nerves are still proximal to the location of the surgical incision

D. Provides the clearest view of the nerves when visualized with the ultrasound

B is correct. At the level of the infraclavicular block, the neurovascular bundle is relatively deep to the skin as compared to the supraclavicular and interscalene blocks. Because of the fact that it lies under the pectoral muscles, a continuous infusion catheter would have a decent amount of space to be tunneled through to prevent dislodgement.

A is incorrect. Below the clavicle, it is unlikely that there will be phrenic nerve impairment as a side effect of this block. Although there is a risk of pneumothorax, if there are no complications during the procedure and it was well visualized, the patient should have less of risk of complaining of respiratory symptoms.

C is incorrect. At this level, the cords of the plexus are being blocked and it is below the clavicle. Although they are still proximal to the shoulder, there are small branches of the plexus that have already split off before the level of the infraclavicular block. Most notable is the suprascapular nerve, which branches at the level of the trunks and provides much of the sensation to the shoulder.

D is incorrect. As mentioned, this block is deeper than other approaches to the brachial plexus and as such, the image is not as clear. The nerves surround the axillary artery with a high amount of anatomic variation. Thankfully, they are almost always still located within very close proximity to the artery so visualization of spread around the artery will be sufficient.

A 68-year-old man with end-stage renal disease, hypertension, history of coronary artery bypass graft (×4), peripheral artery disease, and chronic obstructive pulmonary disease is scheduled for insertion of a brachiobasilic prosthetic graft for future hemodialysis access. If planning a regional technique as the primary form of anesthetic in this patient,

A. It is appropriate to perform an axillary block on either the right or the left arm with a supplemental musculocutaneous block.

B. It is appropriate to perform an interscalene block to completely block sensation to the arm if the surgery ...

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