Infraclavicular approaches to brachial plexus anesthesia

Abstract

The infraclavicular approach to the brachial plexus was reintroduced in 1973. The technique described differed from previous infraclavicular techniques in that the needle was introduced more medially from the place of entry and was directed laterally. The author reasons that needle penetration to any depth would be safe and always outside of the thoracic cavity if directed in that fashion. Thus, with this technique, there is practically no danger of pneumothorax, an obvious advantage over supraclavicular and previously described infraclavicular techniques. Furthermore, with this technique the local anesthetic solution is deposited inside the brachial plexus sheath above the level of the formation of the musculocutaneous and axillary nerves, an apparent advantage over the axillary perivascular techniques. The author also points out two additional advantages of his technique: (1) the ulnar segment of the medial cord is readily blocked, which is an advantage over the interscalene technique; and (2) the intercostobrachial nerve is also blocked consistently. The infraclavicular approach also provides larger skin surface area to introduce the needle from and place the catheter, for prolonged analgesia, than other approaches to brachial plexus. Hence, the infraclavicular technique has some appealing theoretical advantages.