TY  - CHAP
M1  - Book, Section
TI  - Chapter 26. Supraclavicular Brachial Plexus Block
A1  - Franco, Carlo D.
A2  - Hadzic, Admir
PY  - 2007
T2  - NYSORA Textbook of Regional Anesthesia and Acute Pain Management
AB  - The  supraclavicular  block  is  one  of  several  techniques  used  to  anesthetize  the  plexus.  The  block  is  performed  at  the  level  of  the  brachial  plexus  trunks  where  almost  the  entire  sensory,  motor,  and  sympathetic  innervation  of  the  upper  extremity  is  carried  in  just  three  nerve  structures  confined  to  a  very  small  surface  area.  Consequently,  typical  features  of  this  block  include  rapid  onset,  predictability,  and  dense  anesthesia.1–3  In  1911  Kulenkampff  in  Germany  performed  the  first  percutaneous  supraclavicular  approach,  reportedly  on  himself,  a  few  months  after  Hirschel  described  a  surgical  approach  to  the  brachial  plexus  in  the  axilla.  The  technique  was  later  published  in  the  United  States  in  1928  by  Kulenkampff  and  Persky.4  As  they  described  it,  the  technique  was  performed  with  the  patient  in  the  sitting  position  (“a  regular  chair  will  suffice”)  or  in  the  supine  position  with  a  pillow  between  the  shoulders  if  the  patient  could  not  adopt  the  sitting  position.  The  operator  sat  on  a  stool  at  the  side  of  the  patient.  The  needle  was  inserted  above  the  midpoint  of  the  clavicle  where  the  pulse  of  the  subclavian  artery  could  be  felt  and  it  was  directed  medially  toward  the  spinous  process  of  T2  or  T3.  Kulenkampff's  familiarity  with  brachial  plexus  anatomy  allowed  him  to  recognize  that  “the  best  way  to  reach  the  trunks  was  in  the  neighborhood  of  the  subclavian  artery  over  the  first  rib.”  His  technique  was  also  simple;  “all  the  branches  of  the  plexus  could  be  anesthetized  through  one  injection.”  These  two  assertions  are  still  valid  today.  Unfortunately  his  advice  on  needle  direction  carried  an  inherently  high  risk  of  pneumothorax.  The  popularity  of  the  supraclavicular  block  remained  high  during  the  entire  first  half  of  the  twentieth  century  until  well  after  World  War  II.  During  this  time  the  technique  underwent  several  modifications,  most  of  them  intended  to  deal  with  the  risk  of  pneumothorax.1,5–8  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=3501393
ER  -