Supraclavicular blocks of the brachial plexus

The concept of a continuous perineural and perivascular space surrounding the brachial plexus from roots to terminal nerves, allows the injection of a local anesthetic at any level from the neck to the axilla. A complete anesthesia of the entire upper extremity can be simple, safe and effectively provided by blocking the brachial plexus using any supraclavicular approach. At the supraclavicular fossa the plexus is most compactly arranged and local anesthesia is delivered at the trunks level. The different approaches described, can be performed with the upper extremity in any position especially in those patients not suitable for an axillary block. All the supraclavicular approaches offer a high success rate and avoid the sparing of the ulnar nerve with the interscalene technique and the musculocutaneous often missed with the axillary block. All these approaches carry a greater risk of pneumothorax. With the use of the peripheral nerve stimulator, the old Kulenkampff technique is now in a period of renaissance.