Supraclavicular vs. Infraclavicular?

[soorg]

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Which one are you using? Either one better/faster than the other? With U/S or not?

 

[cchoukal]

supra, with ultrasound. 99 out of 100 times it's a chipshot.

 

[New2Midwest]

Supraclav. Ultrasound guided-block sets up in about 5-10 minutes with ropi 0.5% with epi; 5 minute set-up with mepi 1.5% with epi/bicarb

 

[Dimoak]

Much of the recent literature favors supra, in the absence of COPD, trauma, etc.

 

[bostonblaz]

supra, to do infra you have to go threw pec major and minor and in a muscular young person that can hurt for a few days(like the flu shot in the deltoid)

 

[SleepIsGood]

Much of the recent literature favors supra, in the absence of COPD, trauma, etc.

What data are you referring to? And under ultrasound or without it?

Everyone I talk to states that the infraclavicular block is superior. Why, well a big one is the decreased chance of PTX.

Although I believe with a supra block you are typically blocking for surgeries above the elbow and with axillary ones below the elbow...

 

[New2Midwest]

You are misinformed; a supraclavicular block is for blocks from the mid-humerus and distal. In essence, under ultrasound guidane, a supraclavicular block can function like an interscalene block and cover most of the shoulder if you cover all the trunks/divisions.

 

[Planktonmd]

How about a simple interscalene block??
No ultrasound, nerve stim, 3 minutes you are done.
I know, it's too simple 😀

 

[Dimoak]

What data are you referring to? And under ultrasound or without it?

6 Arcand G, Williams SR, Chouinard P, et al. Ultrasound-guided infraclavicular versus supraclavicular block. Anesth Analg 2005; 101: 886–90
Full text at http://www.anesthesia-analgesia.org/cgi/reprint/101/3/886.pdf

I was referring to US w/o nervestim. But even with nervestim, supra produces the superior block (87% initial success with supra vs. 80% with infra), as well as no need for supp due to radial anesthesia loss, vs. 18% rate of supp necessity with infra.

Everyone I talk to states that the infraclavicular block is superior. Why, well a big one is the decreased chance of PTX.

Perhaps in terms of procedural comfort as you're far less likely to hit the lung by avoiding the supraclav fossa (or collaterally blocking the phrenic for that matter), but I'm unaware of any literature that supports infra over supra for reasons other than the complication profile, which itself can be reduced with better technique.