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The infraclavicular block is a regional anesthetic technique developed to avoid the side effects and complications of supraclavicular blocks, particularly pneumothorax. It can be used for postoperative pain control for upper extremity surgeries such as the elbow, forearm, or hand. This activity describes the indications, contraindications, and potential complications of the infraclavicular block and highlights the role of the interprofessional team in the management of patients undergoing this procedure. Objectives: Discuss the technique for performing an infraclavicular block. Describe the indications for an infraclavicular block. Specify the complications associated with an infraclavicular block. Employ a structured, interprofessional team approach to provide effective care to and appropriate surveillance of patients undergoing infraclavicular blocks. Access free multiple choice questions on this topic.

The infraclavicular block is a brachial plexus block used as an alternative or adjunct to general anesthesia. It can be used for postoperative pain control for upper extremity surgeries such as the elbow, forearm, and hand, but not the shoulder. The infraclavicular block is a regional anesthetic technique developed to avoid the side effects and complications of supraclavicular blocks, particularly pneumothorax. The infraclavicular block is a regional anesthetic technique designed to prevent the side effects and complications of supraclavicular blocks, particularly pneumothorax. The advantage of an infraclavicular block is decreased complications with ultrasound, and it is ideally suited for catheter usage. The disadvantage is that the brachial plexus is located deeper and the angle of approach is more acute making visualization of the anatomy and handling a needle at the same time challenging unless the healthcare professional is experienced in performing the procedure. The procedure is also challenging in patients with obesity for these same reasons.[1] Bazy first described the infraclavicular block in 1914, and Speigel described the infraclavicular trans-pectoral perivascular technique in 1967.[2] Raj[3] modified the technique and reported a new approach with higher success rates using a nerve stimulator in 1973. Sims developed the lateral infraclavicular block in 1976 to present a more consistent performance with a constant landmark: the coracoid process.[4] Many approaches have been described since that time, but the most frequent approach today is a sagittal scan at the lateral infraclavicular fossa (LICF).[5]

Possible complications of infraclavicular nerve blocks vary between each technique and volume of LA used but may include: Infection Bleeding: Lesser potential risk in coagulopathic patients with a costoclavicular technique[16] Hematoma Vascular puncture Needle induced paresthesia Nerve injury Intravascular/intraneural injection Local Anesthetic Systemic Toxicity (LAST) Allergic reactions Horner syndrome Hemidiaphragmatic paralysis Pneumothorax

There are a variety of brachial plexus blocks. Knowing how to perform these procedures, including the limitations of each technique is beneficial. Often a surgeon may prefer a specific type of brachial plexus block. The advantages of infraclavicular block include comprehensive upper extremity anesthesia, a lower incidence of tourniquet pain, and a preferable site for catheter insertion making it the preferred approach to brachial plexus blockade.[18] There are rare case reports of pneumothorax[19] and hemidiaphragmatic paralysis,[20](Level V) but this remains less than with other approaches. Ultrasound guidance shows improved performance time, success rate, and decrease the risk of associated complications. A comprehensive, retrospective study of 1146 patients who received US-guided ICB had a success rate of 99.3%, with no reported cases of nerve injury, pneumothorax, or local anesthetic toxicity.[21] (Level I) The nurse is an integral part of the team as she or he will monitor for complications during and after the procedure including hematoma, bleeding at the puncture site, and paresthesias. (Level V) Continuous catheters can be safely secured to the upper chest wall and monitored by nurses. An interprofessional approach will provide the best patient outcomes.