Hadzic's Regional Anesthesia > Part III. Clinical Practice of Regional Anesthesia > Section Five. Upper Extremity Nerve Blocks > Chapter 26. Supraclavicular Brachial Plexus Block Carlo D. Franco, MD

Supraclavicular Brachial Plexus Block: Introduction

"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..."