Brachial Interscalene Supraclav Supraclav Infraclav Infraclav Axillary

Plexus Block classic Plumb bob classic Modified

By Doaa coracoid
Kamal
Aim Block roots/ trunks Divisions Divisions Cords Cords Cords
Indications Shoulder Spinal of UL Spinal of UL Distal upper arm Distal upper arm Distal upper arm
upper arm Not suitable 4 Not suitable 4 Forearm Forearm forearm
proximal forearm shoulder shoulder (ulnar sparing) (ulnar sparing) hand
(ulnar sparing) Suitable 4 tourniquet Suitable 4 tourniquet Not for tourniquet
CI # CPOD COPD COPD
Pt Prep Consent, monitoring, sterilization , draping, sedation. .. . ..
Technique: Supine Supine Supine Supine Supine supine
Position Hd rotated opp side Hd rotated opp side Hd rotated opp side Hd rotated/neutral Hd rotated/neutral arm abducted &
45o 45o circumducted, hand
behind hd
Needle size: G 22 G 22 G 22 G 22 G 22 G 22
Length 1.5 inch 1.5 inch 1.5 inch 3 inch 3 inch 1.5 inch
Bevel B B B B B B
Point of insertion Groove bet scal ant 1 finger above Midpoint of clavicle Midpoint of clavicle 2cm medial, 2cm Point of max arterial
&scal medius. Level of midpoint of clavicle lat border of caudal to coracoid pulsations
cricoid C6 sternomastoid process
Direction Slightly medial, caudal, Slightly caudal, lateral perpendicular Lateral, toward hd of perpendicular Perpendicular, transfix
dorsal toward supraclav A humerus axillary A, axillary
pulsations sheath (needle
pulsations/ feel click)
N identification:
Parasthesia
N (+) MER
Motor evoked response: contraction of any muscle of the upper limb ..
US
LA volume After ve aspiration 30- 30-40 ml 30-40 ml 30-40 ml 30-40 ml 30-40 ml + distal
40 ml + proximal pr digital pr/tourniquet
Complications Horner, phrenic N, Pneumothorax Pneumothorax
vertebral A, epidural