[Technique of supraclavicular brachial plexus block with interscalene approach for shoulder and arm surgery]

Abstract

A technique is described which combines the advantages of interscalene (IS) and supraclavicular block (SCB) and avoids their disadvantages due to complications such as pneumothorax, high spinal and epidural block, cervical plexus block, puncture of a. subclavia and a. vertebralis. The technique has been applied on 110 patients with I-II degree of ASA functional status and indicated for surgical or plysiotherapeutic treatment at the region of the shoulder and upper extremity. The IS approach is based on the reference points and site of insertion of the regional needle described by Winnie, as in the classical ISB. The caudally inserted canule into the inter-scalene spece and a catheter through it provide supraclavicular distribution of the local anesthetic agent--1% Lidocaine and Adrenalin (1:200,000). The effectiveness, security and ability for control through the proposed technique of the brachial plexus anesthesia are investigated. The results we obtained prove an effective block in 93% of the patients together with a low incidence of complications, which determines the technique as a method of choice in the planned, urgent and outpatient surgery.