How Long Does a Supraclavicular Nerve Block Last?

May 28, 2020

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What is a supraclavicular nerve block?

A supraclavicular nerve block is a procedure to block the sensation in the arm below the shoulder.

A supraclavicular nerve block is a procedure to block the sensation in the arm below the shoulder. An anesthetic injection is administered in the area above the collarbone (clavicle) close to the network of nerves (brachial plexus) that provides sensation to the upper extremities. An alternative to supraclavicular nerve block, the interscalene nerve block, is also used to anesthetize the same array of nerves. In an interscalene block, the injection is administered in the neck, closer to the nerve roots.

An interscalene block provides more effective anesthesia to the shoulder but may not effectively block some parts of the hand and fingers. With sufficient anesthetic, a supraclavicular nerve block can diffuse to the shoulder area as well.

A supraclavicular nerve block is the quickest and most effective block for the entire arm because the nerves are tightly packed in the targeted anatomical region (brachial plexus). This approach also carries less chances of blocking the phrenic nerve, which is responsible for the diaphragm’s function that is crucial for breathing.

History and development

The supraclavicular nerve block was first introduced in 1911. Originally, however, the procedure carried a high risk for lung collapse (pneumothorax) because the lung is near the injection site. With the use of ultrasonography for visualizing the needle tip, blood vessels in the region, and the lung’s protective membrane (pleura), pneumothorax risk is now greatly reduced.

Why is a supraclavicular nerve block performed?

A supraclavicular nerve block is usually performed prior to surgeries and for post-operative pain relief (analgesia) in the upper extremities. It may be combined with a wrist block for increased effect in the hand and fingers.

The supraclavicular nerve block may also help manage chronic pain from rheumatoid and degenerative arthritis. Along with painkillers, steroids can be injected to reduce inflammation.

A supraclavicular nerve block is avoided in the following situations:

Infection in the injection site
Allergy to local anesthetics
Presence of splint, cast or dressing in the area
Bleeding disorder
Systemic infection

How is a supraclavicular nerve block performed?

A supraclavicular nerve block may be performed as an outpatient procedure for chronic pain management. Supraclavicular nerve block performed before surgery and for post-surgical pain may involve hospitalization for a day or two, depending on the complexity of the surgery.

Preparation

The patient lies flat or semi-reclines, with their face turned away from the side where the nerve block is administered.
The injection site is sterilized with antiseptic.
Mild sedation may be administered.
The patient’s heart rate, blood pressure and oxygen levels are monitored.

Procedure

The doctor, who may be a hand surgeon or general surgeon

Uses ultrasound guidance during the entire procedure for accurate positioning, angle of the needle, and administration of the anesthetic.
May use a nerve stimulator to confirm the correct location of the nerve by producing a tingling sensation (paresthesia).
Inserts the needle and injects anesthetic.
Aspirates the needle to ensure the needle has not punctured a blood vessel.
Tells the patient to take a deep breath to make sure the pleura is not punctured.
Advances the needle close to the brachial plexus, making sure to avoid hitting the nerve directly.
Injects the anesthetic slowly.
Withdraws the needle and waits approximately 10 minutes for the nerve block to take effect.
Inserts a thin flexible tube (catheter) through the needle, to provide continuous post-surgical pain relief, if required for more extended periods.

After the procedure

The patient will be monitored for a few hours.
Recovery will depend on the type of surgery performed.

QUESTION

Medically speaking, the term “myalgia” refers to what type of pain?
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