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REGIONAL ANESTHESIA

Ultrasound-Guided Supraclavicular Brachial Plexus Block

Vincent W. S. Chan, MD^*, Anahi Perlas, MD^*, Regan Rawson, RN, and Olusegun Odukoya, MD

*Department of Anesthesia, University of Toronto; and Department of Anesthesia, Toronto Western Hospital, Toronto, Ontario, Canada

Address correspondence and reprint requests to Vincent Chan, MD, Department of Anesthesia, Toronto Western Hospital, University Health Network, 399 Bathurst St., Toronto, Ontario, Canada M5T 2S8. Address e-mail to vincent.chan{at}uhn.on.ca

In this study, we evaluated state-of-the-art ultrasound technology for supraclavicular brachial plexus blocks in 40 outpatients. Ultrasound imaging was used to identify the brachial plexus before the block, guide the block needle to reach target nerves, and visualize the pattern of local anesthetic spread. Needle position was further confirmed by nerve stimulation before injection. The block technique we describe aligned the needle path with the ultrasound beam. The block was successful after one attempt in 95% of the cases, with one failure attributable to subcutaneous injection and one to partial intravascular injection. Pneumothorax did not occur. Our preliminary data suggest that a high-resolution ultrasound probe can reliably identify the brachial plexus and its neighboring structures in the supraclavicular region. The technique of real-time guidance during needle advancement can quickly localize nerves. Distinct patterns of local anesthetic spread observed on ultrasound can further confirm accurate needle location.

IMPLICATIONS: Real-time ultrasound imaging during supraclavicular brachial plexus blocks can facilitate nerve localization and needle placement and examine the pattern of local anesthetic spread.

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