Describe
the infraclavicular approach to blocking the brachial plexus.
There are several different approaches to the
infraclavic-ular block. One effective technique uses the coracoid process as
the major landmark. With the patient supine, head turned to the contralateral
side, and arms at the side, the coracoid process is identified. One then
measures 2 cm caudad and 2 cm medial to the coracoid. Using a 22G 4-inch insulated needle attached to a nerve
stimulator, the needle is aimed posteriorly and laterally. When forearm and
hand twitches are elicited at or below 0.4 mA, the local anesthetic is
injected, making sure to aspirate after every 5 cc. A catheter can be inserted for
postoperative pain relief. For a long-acting block, 40 cc of bupivacaine 0.5%
is effective.
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