Supraclavicular nerve block

Searle or Chang approach

Chang: parallel to clavicle, in dip of neck. Look for pleura (fuzzy parallel lines) & rib (single echogenic line with acoustic shadow). AVOID PLEURA! Nerve plexus -> artery -> vein (brachiocephalic valve may be present)

Searle: parasagital (at approx 60 degrees to Changs) in dip of neck

Clinical tips:

  • Do for deepest targets first
  • Up to 30ml of mix (1:1 of 1% prilocaine + 0.25% bupivicaine)
  • Supplement with peripheral nerve blocks 5ml of 0.5% bupivicaine

 

Links:

http://www.jaypeejournals.com/eJournals/ShowText.aspx?ID=542&Type=FREE&TYP=TOP&IN=_eJournals/images/JPLOGO.gif&IID=53&isPDF=YES

http://www.cambridgeorthopaedics.com/cambridgeanaesthetics/advancednerveblocks/Supraclavicular%20block.htm

From Derby Upper Limb Regional Course & clinical training at RDH

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