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   Response - Proposals should be directed to [Prakruthirv08@gamil.com].
   


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 One of the most popular methods of administering anaesthesia and pain releif for upper limb surgery is a regional brachial plexus block. Brachial plexus can be blocked by supraclavicular, infraclavicular, costoclavicular, axillary and  interscalene approaches.

The use of ultrasound in these blocks enhances the success rates and reduces complications significantly. It improves the visualisation of nerve bundles, enables real time assessment of needle placement and this has lead to reduction in the total volume of anaesthetic drugs required. It also helps in avoiding crucial structures such as pleura, blood vessels and  enhances the precision of the local anaesthesic drug infiltration along the targeted nerves.

Supraclavicular brachial plexus block(SCBPB) is often called the  spinal  anaesthesia of the arm, due to its rapid onset of blockade. For the supraclavicular (SC) approach, the trunk and divisions of the brachial plexus are arranged compactly superolaterally around the subclavian artery at the supraclavicular fossa. However, complications such as hemidiaphragmatic paralysis due to phrenic nerve blockade, Horner’s syndrome due to sympathetic nerve block and pneumothorax may occur.

Costoclavicular approach of BPB is a modification of ultrasound guided infraclavicular approach of BPB. Under ultrasound guidance, the costoclavicular space (CCS) is visualised as a well defined intermuscular space , lying deep and posterior to midpoint of clavicle. It is located between the clavicular head of pectoralis major and subclavius muscle anteriorly and the upper slips of serrtus anterior muscle and second rib posteriorly.  All 3 cords of brachial plexus are more superficial and visualized in a single transverse sonogram of CCS as the cords are clustered together lateral to axillary artery. Therefore a a low dose of LA(local anaesthetic) and single injection would provide more effective blockade. Block needle can be easily directed to the centre of the plexus with minimal discomfort to patient.

The danger of vascular puncture and pleural puncture is minimized with costoclavicular approach as the nerve cords are first approached before vessel and the pleura.