1. BRACHIAL PLEXUS BLOCK
Dr. Rupak Bhattarai

2. Anatomy
The brachial plexus is derived from the cervical roots C5, C6, C7, C8 and the thoracic root T1. The plexus runs from the neck to the axilla passing between the clavicle and the first rib. In the axilla the plexus forms 3 cords which surround the axillary artery - the posterior, lateral and medial cords. The cords form the nerves to the arm - the median, ulnar, radial and the musculocutaneous nerve. Alongside the axillary artery runs the axillary vein.

5. Technique for Brachial Plexus Block
Interscalene Brachial Plexus Block
Supraclavicular(Subclavian)Brachial Plexus Block
Infraclavicular Brachial Plexus Block
Axillary Brachial Plexus Block

6. Indication
Forearm and hand surgery

7. Interscalene approach:

8. Supraclavicular(Subclavian approach):

9. Infraclavicular approach:

10. Axillary approach:

11. Detail Technique of Supraclavicular approach
The patient is positioned supine with the head turned 30 degree to the contralateral side.
The interscalene groove is palpated at its most inferior point which is just posterior to the subclavian artery pulse, which can be felt just medial to the midpoint of the clavicle.
Another technique is just measure the whole length of the clavicle and midpoint of the just above the clavicle is the point one needs for the supraclavicular approach.

12. After a skin wheal with local anesthesia, a 22-guage ,1
After a skin wheal with local anesthesia, a 22-guage ,1.5 inch needle is directed just above and posterior to the subclavian Pulse and directed caudally against the skin.
The needle is advanced until a paresthesia is encountered or muscle contraction of a forearm is noted.
If the paresthesia or contraction is still observed ,then ml of local anesthesia is injected.
If the rib is encountered without a paresthesia or if blood is encountered, then the needle is withdrawn and the landmarks of the needle insertion path are re-evaluated.

13. Complication
Phrenic nv and recurrent laryngeal nv blocked leading to respiratory failure and Horner’s syndrome with dyspnea and hoarseness of voice.
Puncture of the pleura may cause Pneumothorax.
Hemothorax.
Hematoma and Infection.
Chylothorax