Supraclavicular Block - Regional anesthesia Crash course with Dr. Hadzic

The supraclavicular block is one of several techniques used to anesthetize the brachial plexus. The block is performed at the level of the brachial plexus trunks where almost the entire sensory, motor, and sympathetic innervation of the upper extremity is carried in just three nerve structures confined to a very small surface area. Consequently, this technique typically provides a predictable, dense block with rapid onset. In 1911, Georg Hirschel described a surgical approach to the brachial plexus in the axilla. A few months later, Diedrich Kulenkampff, in Germany, performed the first percutaneous supraclavicular approach, reportedly on himself. The technique was published in 1928 by Kulenkampff and Persky. As they described it, the technique was performed with the patient in the sitting position (“a regular chair will suffice”) or in the supine position with a pillow between the shoulders. The operator sat on a stool at the side of the patient. The needle was inserted above the midpoint of the clavicle where the pulse of the subclavian artery could be felt and was directed medially toward the spinous process of T2 or T3. Kulenkampff ‘s familiarity with brachial plexus anatomy allowed him to recognize that “the best way to reach the trunks was in the neighborhood of the subclavian artery over the first rib.” His technique was also simple: “all the branches of the plexus could be anesthetized through one injection.” These two assertions are still valid today. Unfortunately. his advice on needle direction carried an inherently high risk of pneumothorax. The popularity of the supraclavicular block remained unrivaled during the entire first half of the 20th century until well after World War II. During this time the technique underwent several modifications, most of them intended to reduce the risk of pneumothorax. The introduction of axillary techniques by Accardo and Adriani in 1949 and by Burnham10 in 1958 marked the beginning of the decline in enthusiasm for the supraclavicular block.
Supraclavicular Brachial Plexus Block - Landmarks and Nerve Stimulator Technique:
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00:00 Introduction
00:25 Anatomy
3:14 Technique
5:25 Ending
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Disclaimer:
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 TH-cam channel is accurate.

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[@sallehasamad9543]

Great video. I still remember your teachings back in the days along with Prof Karmakkar in Beijing/HK.

[@jelenakotaran7438]

Hvala vam dr Hadžić na svom znanju koje prenosite🤲 Thank you...

[@sudiptaandroid1616]

Hadzic sir ...u are a ROCKSTAR !!!!! Respect !!

[@nysoravideo]

Hi Sudipta, Glad to hear this! Thanks!

[@marisabotes989]

So simple and so helpful!! Thank you from South Africa!

[@nysoravideo]

Glad it was helpful! Thank you!

[@memongn]

nice presentation, we always learn from your videos dear Hadmic, you make our job and life easy

[@nysoravideo]

Glad to hear that!

[@ilopezgMD]

Use to read nysora's webpage when I was a resident, now I see your videos in TH-cam as a practitioner. Still dream with living in NY and attend to Nysora. Greetings from México

[@nysoravideo]

Hi ilopezgMD! So kind of you, and we are really glad you are enjoying our work. Greetings from NYSORA!

[@jacobbelenky7585]

Good job Admir , you are a true expert !

[@nysoravideo]

Thanks!

[@zakalobi80]

Great illustration. I think second injection above the upper trunk is as good. sometimes, I inject at the level of divisions. Thank you for sharing that.

[@nysoravideo]

Thanks for sharing!

[@gabrun5441]

Perfectly explained, thanks a lot

[@nysoravideo]

You are welcome!

[@phillipbguerra]

Thank you from an anesthesiologist in Spain 🇪🇸

[@nysoravideo]

You're welcome!

[@ahmedouennahoui7369]

Great illustration. Thanks

[@nysoravideo]

Thank you!

[@NatureGod-lz2sb]

Perfect!

[@brachialplexus6911]

One of the best video on supraclavicular block. Thank you fro Nigeria

[@nysoravideo]

Glad it was helpful!

[@user-pc3tg3kt8y]

Awesome n very simplified video.. Thank you very much Sir.

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Hi Sanjavini! Thanks for watching. Do subscribe to this channel as there's more coming up. Greetings from NYSORA!

[@ravidsakumar1]

U are a legend
Thank you so much

[@Motivational.Quotes10k]

Thanks for this clear presentation.

[@nysoravideo]

Hi Dan, Glad it was helpful!

[@davelorenz8524]

I love your video tutorials..... It would be helpful if you designated medial and lateral

[@nysoravideo]

Hi Dave! Noted.

[@sribalaji2590]

Wow such an amazing video clearcut concept 🎉❤

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Glad you think so!

[@drahmadfakher]

Many thanks ,very good illustraion

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Thank you! Subscribe to the channel, more videos coming soon.
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[@DrCarlosALanzM]

Great video. Thanks

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You are welcome!

[@user-pl6rb1lu1p]

Wonderful chanel! Thank you, from Russia :)

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Thank you! Greetings to Russia! :)

[@dr.kasifraza4380]

Perfectly explained

[@nysoravideo]

Hi Dr. kasif Raza! Indeed. Thank you for your comment! Make sure you subscribe to the channel so that you do not miss some super educational upcoming videos!

[@drvinod0072004]

Nice demonstration.. thank u

[@nysoravideo]

Glad you liked it

[@Manatelugu_2024]

Thank you sir... It's very useful to beginners

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Hi Vamsi! Thank you for your comment. Keep watching!

[@JAIKUMAR-qn8vl]

U are master, Sir Admir hadzic

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Hi Jai Kumar! Indeed. Thank you for your comment! Make sure you subscribe to the channel so that you do not miss some super educational upcoming videos!

[@ahmedelgamassy4567]

After long years of experience in nerve blocks, I came to a conclusion regarding upper limb blocks which is: out of the 4 approaches to the brachial plexus, you only need to do Interscalene for shoulders and infraclavicular for full arm anesthesia. Forget about the supra clavicle and axillary. By the way the supraclav will miss T2 inteecostobrachial nerve which supply medial arm whereas infra clavicle don’t. Infraclavicular is the true spinal of the upper arm.

[@wafaibrahim369]

Thanks ya for sharing inspiring information experience ♥️♥️♥️♥️♥️♥️♥️♥️♥️♥️♥️

[@nysoravideo]

Hey Wafa Ibrahim! Thank you for your comment! Make sure you subscribe to the channel so that you do not miss some super educational upcoming videos!

[@haliShanna]

One don't need to inject LA inside the sheet. Instead ,you shot between the 1st rib and the sheet and the 2nd shot is above the sheet, you kinda sandwich the plexus between eh two shots. Done it and worked oerfectly.

[@nazirahidris]

That was awesome

[@nysoravideo]

Thank you!

[@mahmoudali3588]

Where do we put the ultrasound probe??

[@SamtaniPradeep]

Sir how to cover posterior cutaneous nerve of arm which is site of incision in distal humerus or elbow surgery which is frequently spared in this block??

[@venkataramanjanardhanan3201]

Awesome 👏👏👏👏

[@nysoravideo]

Thanks!

[@rodgero]

Very nice video. Do you use the Supraclavicular Block for Carpal Tunnel Releases?

[@nicolascrescimone]

No

[@AJohnson0325]

That would be overkill in my opinion. Most people where I work would just do a general with LMA and let the surgeon localize. These are quick cases but the surgeon uses a tourniquet and the bed will be turned 90 degrees from the anesthesia machine.

[@davelorenz8524]

I love your video tutorials..... It would be helpful if you designated left and right

[@nysoravideo]

Noted!

[@omar-iv9xi]

Thanks a lot

[@nysoravideo]

Most welcome

[@02hreblue30]

awesome.

[@nysoravideo]

Thanks!

[@plimbu]

do u recommend needle bevel to be downwards on all blocks? I also do find that the double tip seems to disappear when the bevel is downwards but bevel up seems to be easier during insertion & less painful. or does it only matter in fascial plane blocks when the accuracy of needle tip is of outmost important?

[@memongn]

we do puncture site analgesia

[@memongn]

needle tip visualization is basic, we dont move under needle cut is that is bevel is under vision

[@DavidMartinez-zz6eh]

What do you think about medial aproximation?

[@mistycool]

i just had this done

[@wafaibrahim369]

♥️👌🏽👌🏽✌🏼👌🏽

[@lorepreagui6816]

I luv u😊

[@nysoravideo]

We love you back!

[@ml2539]

This vid is not on the app…the paid app just the 3D anatomy.