The infraclavicular brachial plexus block

The infraclavicular brachial plexus block is still an underused technique for regional anesthesia of the upper limb, but represents a reliable and safe approach for surgery of the hand, the forearm, the elbow, and the antecubital fossa, also involving the musculocutaneous nerve. This report intends to describe, as well as the anatomical evidence, an infraclavicular technique modified by Grossi, in which the arm is adducted or in a rest position. Vertical direction of the needle and electrical nerve stimulator with insulated needle is required. An historical review of infraclavicular blocks and their relation with other approaches are reported. Evident advantages are represented by compliance of the patient, tourniquet tolerance, usefulness of this approach to place a catheter, an alternative to the axillary approach in presence of joint stiffness or ankylosis, fractures of the limb, local infection or scars, and previous axillary lymphoadenectomy. The possible complications are related to pleural or vascular puncture. No impairment of the respiratory function or involvement of the phrenic nerve is reported.