From the FDA Drug Label
The 5 mg/mL (0.5%) ropivacaine hydrochloride solution gave success rates from 56% to 86% for axillary blocks, compared with 92% for supraclavicular blocks.
The coverage area of a supraclavicular nerve block is not explicitly stated in the provided text. However, it can be inferred that a supraclavicular block is used to anesthetize the brachial plexus, which suggests that the coverage area includes the nerves of the upper limb, but the exact area is not specified 1.
From the Research
A supraclavicular nerve block provides anesthesia to the upper extremity, covering the shoulder, arm, forearm, and hand, with the exception of the axilla and medial upper arm, which are innervated by the intercostobrachial nerve. This block targets the brachial plexus at the level of the trunks and divisions, effectively blocking the entire upper limb below the shoulder. The block typically uses 15-30 mL of local anesthetic, commonly bupivacaine 0.5%, ropivacaine 0.5%, or lidocaine 1-2% with epinephrine, as seen in the study by 2. For longer duration, bupivacaine or ropivacaine are preferred, providing 8-12 hours of anesthesia, while lidocaine offers 2-4 hours.
When performing this block, ultrasound guidance is recommended to visualize the subclavian artery, first rib, and pleura to ensure accurate needle placement and reduce complications, as noted in the studies by 3, 4, and 5. Potential complications include pneumothorax, vascular puncture, phrenic nerve paralysis, and Horner's syndrome. The block's effectiveness stems from the anatomical convergence of the brachial plexus components at the supraclavicular level, allowing comprehensive coverage with a single injection.
Some key points to consider when performing a supraclavicular nerve block include:
- The use of ultrasound guidance to reduce complications and improve block effectiveness, as seen in the study by 4
- The importance of blocking the intercostobrachial and medial brachial cutaneous nerves separately, as they are not part of the brachial plexus, as noted in the study by 5
- The choice of local anesthetic and dosage, with 15-30 mL of 0.5% ropivacaine or bupivacaine being commonly used, as seen in the study by 2
- The potential for complications, such as pneumothorax and phrenic nerve paralysis, and the need for careful monitoring and management, as noted in the studies by 3 and 5.
Overall, a supraclavicular nerve block is a effective and reliable method for providing anesthesia to the upper extremity, with a high success rate and minimal complications when performed with proper technique and precautions, as seen in the studies by 2, 3, 4, 6, and 5.