Brachial plexus blocks:
Comparison:
|
|
INTERSCALENE |
SUPRACLAVICULAR |
INFRACLAVICULAR |
AXILLARY |
|
Structure |
Trunks |
Divisions |
Cords |
Branches |
|
Hits |
Shoulder Proximal arm |
Arm Elbow Forearm ±Hand |
Elbow Forearm Hand |
Forearm Hand |
|
Misses |
Entire inferior trunk (C8,T1) T2 |
Suprascapular nerve ±Inferior div’n (C8,T1) Angle probe caudad Aim for corner pocket T2 |
Suprascapular nerve T2 |
Musculocut nerve (separate) MCNA MCNF LCNF (musculocut) T2 |
|
Whoops |
Phrenic (3/3) -obstructive: not so bad -restrictive: disaster SNS (Horner’s) Vertebral artery Epidural spread RLN palsy |
Phrenic (2/3) Pneumothorax Subclav a, dorsal scap a. |
Phrenic (1/3) Pneumothorax |
Nothing really |
|
Position |
Semi-recumbent Head tilted |
Semi-recumbent Head tilted |
Supine Head tilted |
Supine Street protest position (arm abducted, elbow 90°) |
|
Probe |
Straight |
Straight |
Curved |
Straight |
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Brachial plexus:
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