26 Supraclavicular Nerve Block

The supraclavicular nerve (SCN) is a branch of the superficial cervical plexus (see Fig. 60-1). It arises from the third and fourth cervical ventral rami and divides into three branches: medial, intermediate, and lateral. These branches are about 1 to 2 mm in diameter. The intermediate branch can in some cases be palpated over the midportion of the clavicle. The nerve has sensory fibers to the clavicle and shoulder, the chest wall to the level of the second rib, and the acromioclavicular and sternoclavicular joints. The supraclavicular branches usually pass over the clavicle but in some cases can actually travel through the clavicle. Block of the SCNs is useful for pain relief from shoulder or clavicle surgery.^1,²

Suggested Technique

The traditional supraclavicular block of the brachial plexus is not considered adequate for shoulder surgery.³ Sensory blockade of the supraclavicular and axillary nerves has slower onset for the traditional supraclavicular technique compared with the interscalene technique of brachial plexus anesthesia. However, ultrasound-guided infiltration of local anesthetic for SCN block can augment low interscalene or supraclavicular blocks for shoulder surgery. The SCN is typically located over the prevertebral fascia and brachial plexus near the clavicle. SCN block is generally performed after the brachial plexus block.

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