Retroclavicular vs infraclavicular approaches for ultrasound guided brachial block A comparative analysis for upper limb surgeries

Peripheral nerve block is always a safe alternative to general anaesthesia. Patient remains awake oriented  and with intact airway reflexes throughout the procedure. In addition it offers a better preservation of mental functions in elderly decreased risk of aspiration due to intact pharyngeal and laryngeal reflexes avoids difficult intubation decreases postoperative complications associated with intubation and provide better postoperative analgesia without undue sedation facilitating early mobilization and discharge.

Brachial Plexus block is administered by various approaches viz. supraclavicular infraclavicular interscalenous perivascular subclavian and axillary routes for upper limb surgeries.

The Infraclavicular block is achieved by injecting local anesthetic around the cords of the brachial plexus which are located in the infraclavicular fossa.

It’s commonly used for procedures on the elbow, forearm, wrist, and hand, especially when other approaches like the axillary block are difficult due to patient positioning or other factors.

Compared to other brachial plexus blocks the infraclavicular approach may offer better coverage of the upper arm and easier catheter placement for continuous nerve blocks. It also avoids some of the respiratory complications associated with supraclavicular and interscalene blocks.

The retroclavicular refers to the needle insertion point, which is posterior and deep to the clavicle rather than directly under it as in some other infraclavicular approaches.The patient is typically positioned supine with their head turned away from the side being blocked and a bump under their back to depress the shoulder and clavicle.The needle is inserted 1-2 cm posterior to the clavicle in the supraclavicular fossa kept parallel to the floor.The needle is advanced until it contacts the clavicle then walked off its undersurface, and hydrodissection is used to create space around the posterior cord and artery before injecting the local anesthetic.

Retroclavicular approach provides better needle visualization and lesser time for administration of brachial plexus block. Lesser chances of block related complication.