
Supraclavicular Brachial Plexus Block - ARiRA Pro Tips
Indications: Ideal for surgeries involving the upper limb, from the mid-humerus to the hand. Common procedures include distal humerus fracture fixation, elbow surgery, forearm surgery, wrist surgery, and hand procedures.
Anatomy: Targets the brachial plexus at the level of the trunks and divisions as they pass over the first rib, posterior to the subclavian artery. The plexus appears as a compact cluster of hypoechoic, round-to-oval structures on ultrasound, located lateral and superficial to the artery.
Patient Positioning: Position the patient supine with the head turned away from the block side. A slight elevation of the ipsilateral shoulder may enhance ergonomics. Ensure the arm is abducted slightly to optimise access.
Ultrasound Technique: Use a high-frequency linear probe placed transversely in the supraclavicular fossa. Identify the subclavian artery, with the brachial plexus positioned laterally. The characteristic "grape cluster" appearance of the plexus confirms the target. Adjust depth and gain settings to enhance nerve clarity.
Needle Insertion: Perform an in-plane approach from lateral to medial. Advance the needle carefully under ultrasound guidance to position the tip just adjacent to the brachial plexus. Avoid deep insertion to prevent pleural puncture. Hydrodissection with saline can help delineate the fascial planes.
Injection Volume: Administer 20–30 mL of local anaesthetic to ensure adequate spread around the plexus. Lower volumes (15–20 mL) can be effective when using a perineural catheter or adjuncts.
Phrenic Nerve Sparing: While the risk is lower than with an interscalene block, some phrenic nerve involvement may still occur. Using lower injection volumes and optimising needle placement laterally can help mitigate this.
Reducing LAST (Local Anaesthetic Systemic Toxicity) Risk: Always aspirate before injecting and inject in small increments (3–5 mL) with frequent aspiration.

Supraclavicular Brachial Plexus Block – FAQs
Q: What is the supraclavicular brachial plexus block?
A: It is a regional anaesthesia technique that targets the brachial plexus at the level of the trunks and divisions, providing effective anaesthesia for surgeries involving the distal upper limb.
Q: How does this block compare to the interscalene and infraclavicular blocks?
A: The supraclavicular block offers a balance between the two. It provides more distal coverage than the interscalene block while being technically simpler and requiring less local anaesthetic than the infraclavicular approach. However, it carries a slightly higher risk of pneumothorax than the infraclavicular block.
Q: What are the complications of the supraclavicular block?
A: Potential complications include pneumothorax (rare but significant), vascular puncture, local anaesthetic systemic toxicity (LAST), phrenic nerve involvement (in some cases), and Horner’s syndrome due to stellate ganglion involvement.
Q: How can the risk of pneumothorax be minimised?
A: Use real-time ultrasound guidance, avoid excessive medial angulation of the needle, and utilise hydrodissection techniques to enhance safety. Keeping the needle trajectory parallel to the probe reduces the risk of pleural breach.
Q: How long does the block last?
A: The duration depends on the choice of local anaesthetic. Ropivacaine and bupivacaine typically provide analgesia for 8–18 hours.
Q: Can this block be used for outpatient surgery?
A: Yes, its efficacy and relatively rapid onset make it ideal for same-day discharge procedures, particularly for hand and wrist surgeries.
Q: How do you prevent vascular puncture during this block?
A: Always use ultrasound guidance to identify and avoid the subclavian artery. Aspirate before injection, and if necessary, use Doppler mode to visualise vascular structures more clearly.
Q: How do you differentiate the brachial plexus from surrounding structures on ultrasound?
A: The brachial plexus typically appears as a "grape cluster" of hypoechoic round structures lateral and superficial to the subclavian artery. Dynamic scanning from the interscalene region down to the clavicle can help trace the nerves and confirm identification.
Enhance your nerve block skills with interactive 3D anatomy, cadaver anatomy, augmented reality, ultrasound simulator, virtual probe control and the latest innovative technology at https://www.arira.co.uk
This content has been specifically tailored for healthcare professionals, focusing on unique strategies to optimise safety and efficacy during supraclavicular brachial plexus block procedures. Always apply clinical judgment tailored to individual patient needs.