Supraclavicular Block: WHY, HOW, WHERE, AND WHAT’S NEW
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- čas přidán 25. 10. 2023
- This video provides a short and complete instruction - review of the supraclavicular brachial plexus block. Watch the video to find out WHY, HOW, WHERE, and LATEST Research DIGEST on SCB! The supraclavicular block, frequently termed the "spinal anesthesia of the arm," remains one of the most effective and adaptable regional anesthesia techniques for surgeries of the upper limb. This block zeroes in on the brachial plexus nestled within the supraclavicular fossa, offering comprehensive anesthesia from the humerus to the hand.
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Medicine is an ever-changing science. As new research and clinical experience broaden, changes in treatment and drug therapy are required. The authors and publishers have checked with sources believed to be reliable in efforts to provide accurate information within the available or accepted standards of care. However, given the possibility of human error or changes in medical practice, neither the authors nor the publisher, nor any other party involved in the preparation of this platform warrants that the information contained herein is in every aspect accurate or complete, and they disclaim all responsibility for any errors or omissions for the results obtained from the use of the information contained in this work. Readers are advised to confirm the information contained herein with other sources. For example, readers are advised to check the product information of each drug mentioned, and that any information contained on NYSORA's CZcams channel is accurate.
Would you consider doing a series of videos on "difficult to image" patients. In each video show both your best view, highlight the anatomy, and local spread. I suggest putting many patients on one video. It is one thing to do these blocks on a thin patient versus a 500 pound patient. Also it is good experience seeing difference ultrasounds of the same anatomy.
Dr Feigl was a professor of anatomy at my university during my studies. A great and passionate teacher. Very nice and unexpected to him mentioned here!
Always a pleasure to watch NYSORA presentations. Thanks.
Our pleasure! Thanks for following us.
Thank you for your videos .Thanks to you dr hadzic, I have learned more than I learned from my anesthesiology specialty education.
Those are big words and thank you so much for them.
Hi Prof. Thank you for your videos and app which are a huge help to me. Completely unrelated but have you ever done/know someone who has done a ultrasound guided psoas bursa injection? Would greatly appreciate some advice/guidance
After doing lots, for me the infraclavicular block is the spinal anesthesia of the upper limb. It had never let me down.
A very good advantage also is that it also blocks the intercostobrachial nerve T2 which supplies the medial aspect of the arm that is usually missing with Supra clavicular blocks.
How? t2 is blocked at a different location such as a PEC2 block. Shouldn’t be a difference between infra clav or supraclavicular or even axillary as far as coverage. T2 would still need to be blocked separately.
I need a video of US guided caudal block, I do caudal for robotic prostatectomy, thank you
Sir how do you block the posterior aspect of arm being spared by this block for distal humerus surgeries ??
I had this done today for wrist surgery. Wondering when the pain will return.
A small request: could you please clarify the probe orientation ?
Question. Pregunta :
good morning. Dear NYSORA. Can plexus access, by perforating fascial sheaths, change the staging of a tumor that invades?
buenos días. Estimado NYSORA. puede un acceso a plexo, al perforar vainas aponeuroticas, cambiar la estadificacion de un tumor que invada ??
Great video!
Re: Suprascapular Nerve Block (SSNB) vs. Interscalene Block vs. Supraclavicular Block:
Just look for the Suprascapular Nerve every time you do an ISB or SCB: it's the first nerve to leave the Supraclavicualr plexus when you tilt the probe distally, or, with ISB, trace down nerve root C5 and it will become the SSN once the Omohyoid muscle comes into view (with ISB, I sometimes trace this in reverse to confirm that the nerve root is actually C5). Do this twenty times and you will be ready to do your first SSNB!
I use SSNB routinely for arthroscopic AC joint resection. Out of interest, I have approached about 15 patients by phone the day after surgery who already had the same procedure on the opposite side using ISB: they all preferred SSNB over ISB, mainly because of the lack of "dead limb" sensation for so many hours. Compared to patients with ISB, they will require some oxycodon in the early post-op period, but they will not experience the severe rebound pain which is common when ISB wears off.
Cheers, Anton, the Netherlands
Can´t find the article decribed in the end of the video: ""anatomy of braquial plexus and its implications for daily clinical practice: regional anesthesia is apllied anatomy". Can someone help me out? Thanks in advance.
Looking for it also
I thought cadaveric studies suggest that you should not breach the BPS due to the higher risk of nerve injury. Instead you should do your “8 ball corner pocket” injection to ensure coverage of the inferior trunk and the then a further injection above the superior trunk.
Greetings! Thank you for the feedback. Can you share the references mentioned and we can discuss. Best regards and thank you for watching!
@@DRBLUESNYC www.ualberta.ca/anesthesiology-pain-medicine/media-library/journal-club/jounral-club-article.pdf
This is a study of a single injection (not the double injection you’re advocating). Given the safety implications, my impression is that the highly effective method of surrounding the BPS with local (above and below) is the better recommendation
It’s nicely demonstrated in this vid …
czcams.com/video/m3GU11ZRzGc/video.htmlfeature=shared
Hello
Supra vs infra clavicular nerve block ?
And Thanks +++ for your videos from 🇫🇷
Whenever possible - supraclvaicular - simpler, more effective. Your oppinion/experience? Greetings
@@nysoravideo We do a lot of elbow atrhrolysis procedures requiring the best possible post-op analgesia to help the patients keeping the joint moving, and I routinely use infraclavicular block. In my experience, it provides surgical anesthesia of the elbow. Because of the duration of the surgery, I would typically supply light sedation with low-dose propofol without any opioids. I find it much easier to leave a catheter and I believe it stays in place much better compared to a supraclavicular plexus catheter.
Cheers, Anton, the Netherlands
I would advise having your eyes inline with the probe, not perpendicular.
You had a video about single injection for supraclavicular block, but in this video you recommend two injections. This video seems to contradict this?
Thx for the vid.
Last time i did exactly the 2 injections as shown here ( total volume 30ml 0.5% bupivacaine ) . Plus:
10 ml at the very corner
10 ml above the roots
10 ml between the roots .
I saw the spreading well on ultrasound , pleura was pushed deep by LA , and it was a nice spreading .
It was an elbow fracture open fixation.
And. .. it .. failed !!!
Any idea why ?!
It sounds like you didn´t pierce the fascia in the corner and above the roots, I only use 2 injections of 10 to 15ml each, depending on body size, of Bupivacaine as low as 0.25% and haven't have a failure in a long time, but I make sure I fell the ¨pop¨ telling me I´ve entered the fascia. BTW I Avoid the injection between the roots.
@@intestinomedicinothx for your logical answer , i use the syringe green needle ( sharp G21 1.5”) and don’t feel the pop ..may be i should blunt it .. cause I don’t feel the pop in this area .. what needle do you use ?
You should use a block needle, not a cutting hypodermic green needle
It is difficult to tell based on the description. No block is 100% for surgery. Sometimes it is intraoperative management. That's all we can say with the information provided. Greetings!
1) The goal with ultrasound-guided techniques - is not a "pop" but the distribution of the LA in a specific space. 2) While the technique can be discussed from an anatpmical standpoint, at NYSORA - we never share anything that we do not DO in our clinical practice as a standard. So, it is important to differentiate the theoretical considerations from the practical/pragmatic. Your oppinion/experience? Greetings
Please, We need the book in spanish.
Dear Daniel, our Nerve Block Manual is actually available in Spanish. Here it is: www.amazon.com/NYSORA-Manual-los-Bloqueos-Nervios-ebook/dp/B0CGMDSD27 But you can also check the Spanish and the Mexican version of Amazon if that helps. Best regards.
@@nysoravideo Great!!!