Supraclavicular Approach to Brachial Plexus Block Using Fluoroscopic Anatomic Landmarks and Nerve Stimulation

Abstract

Irritation of neural structures, specifically the brachial plexus outside of the cervical spine is capable of producing pain in the upper extremity. These pain patterns may be similar to pain originating from the cervical spine, presenting a diagnostic challenge. Brachial plexus block is performed at multiple levels, including interscalene, supraclavicular, infraclavicular, and axillary. Interscalene block is frequently utilized by interventional pain management physicians for diagnostic and therapeutic purposes to isolate and manage the brachial plexus as a pain generator. The traditional methods employed in performing interscalene or supraclavicular brachial plexus blocks are associated with multiple disadvantages. A new technique is described to meet five essential requirements encompassing safety, specificity, consistency, reproducibility and a high success rate. Relevant anatomy and proposed technique of brachial plexus block is described. The procedure is performed under fluoroscopy with contrast injection. It is concluded that the proposed technique of brachial plexus block is useful for brachial plexus blockade providing precision and specificity with minimal complications.