A Cadaver Study Investigating Structures Encountered by the Needle During a Retroclavicular Approach to Infraclavicular Brachial Plexus Block

Abstract

The suprascapular nerve is consistently in the path of the block needle posterior to the clavicle. This raises the possibility of risk of injury to the suprascapular nerve when using this approach to the brachial plexus. Vascular injury is also possible deep to the clavicle, and because of the noncompressible location, caution is advised in patients with disordered coagulation.

Retroclavicular vs supraclavicular brachial plexus block for distal upper limb surgery: a randomised, controlled, single-blinded trial

“…Indeed, as demonstrated recently in a cadaveric study, the suprascapular nerve and the suprascapular vein lie in the trajectory of the needle path, and the posterior cord or its components were punctured by a retroclavicular sited catheter in 50% of patients. 9 In our study, however, no patients suffered from persistent paraesthesia or motor weakness at 24 postoperative hours. Second, in cases of vascular injury, the presence of the clavicle does not allow compression of the punctured vessels.…”

“…That said, we would like to emphasise that, when performing the retroclavicular brachial plexus block, the practitioner should be aware of the potential risk of nerve injury or vascular puncture when advancing the needle blindly behind the clavicle. 9 One can argue that a limitation of this study was to compare the retroclavicular with the supraclavicular brachial plexus block, and not with a traditional infraclavicular approach. We elected to compare with a supraclavicular procedure, as this technique is the gold standard in our institution as the superficial location of the anatomical structures facilitates the identification of the needle and the speed of the procedure.…”

Novel approaches to the brachial plexus in the infraclavicular space: filling up the tool box

“…We thank Leurcharusmee and colleagues1 for complementing our study and discussing the various infraclavicular ultrasound techniques to achieve brachial plexus blockade 2. We agree with the authors that there is limited evidence in the literature comparing the retroclavicular block to the para coracoid approach and more studies are needed.…”

Retroclavicular approach to infraclavicular brachial plexus block: a logical conundrum

“…We read with great interest the cadaveric study by Drs Sancheti et al ,1 which explored the structures encountered by the needle tip (under the clavicle) during the performance of the retroclavicular infraclavicular block. We would like to commend the authors for the elegance of their protocol and the timeliness of their findings.…”

“…Unfortunately, the retroclavicular infraclavicular block offers a logical conundrum: in order to better visualize the needle, one cannot see the latter as it passes dorsal to the clavicle. Sancheti et al ’s results eloquently demonstrate potential problems associated with this retroclavicular blindspot, as the needle tip passes in close proximity to the suprascapular nerve and vein 1. Although adjunctive neurostimulation and elicitation of paresthesia may help detect contact with the former, puncture of the latter remains problematic.…”