Patient Education for Supraclavicular Block
Patients receiving a supraclavicular block must be educated about expected sensory and motor changes, potential complications including hemidiaphragmatic paresis and Horner syndrome, and the importance of arm protection during the numbness period.
Pre-Procedure Education
Expected Block Effects and Duration
Patients should expect complete numbness and inability to move the affected arm for 12-18 hours after the block, depending on the local anesthetic used 1.
Explain that the block will provide excellent pain relief for upper extremity surgery, with a 94.6% success rate for complete surgical anesthesia 1.
Warn patients that sensation and motor function will return gradually, and they should be able to perform a straight-leg raise equivalent (arm movement) within several hours of block resolution 2.
Arm Protection Instructions
Instruct patients to protect the blocked arm from injury during the numbness period, as they will not feel pain, temperature, or pressure 1.
Advise using a sling to prevent inadvertent injury from the limp arm hanging or getting caught in objects 3.
Warn against exposure to extreme temperatures (hot or cold) that could cause burns or frostbite without the patient's awareness 1.
Common Side Effects to Expect
Hemidiaphragmatic Paresis
Inform patients that temporary weakness of the diaphragm on the blocked side occurs in approximately 1% of cases, which may cause mild shortness of breath or difficulty taking deep breaths 1.
Reassure that this resolves completely as the block wears off and is not dangerous in patients with normal lung function 1.
Patients with severe underlying respiratory disease should not receive this block due to increased risk 1.
Horner Syndrome
Educate patients that temporary Horner syndrome (drooping eyelid, small pupil, decreased sweating on one side of the face) occurs in approximately 1% of cases and resolves completely when the block wears off 1.
Reassure that this is a benign, temporary effect and does not indicate nerve damage 1.
Serious Complications to Report Immediately
Signs Requiring Emergency Evaluation
Instruct patients to seek immediate medical attention for severe shortness of breath, chest pain, or difficulty breathing, as these could indicate pneumothorax, though this complication is extremely rare with ultrasound guidance (0% in a series of 510 cases) 1.
Report any persistent numbness, tingling, or weakness lasting beyond 24-48 hours, as transient sensory deficits occur in 0.4% of cases but should resolve 1.
Seek evaluation for signs of infection at the injection site (increasing redness, warmth, swelling, or drainage) 4.
Bleeding-Related Concerns
- Patients on anticoagulation should have been appropriately managed pre-procedure, but they should report any unusual bruising, swelling, or pain in the neck/shoulder area 5.
Post-Procedure Care Instructions
Activity Restrictions
Avoid driving or operating machinery until full sensation and motor function return to the blocked arm 1.
Do not make important decisions or sign legal documents while under the influence of any sedation given during the procedure 5.
Pain Management Expectations
Begin taking prescribed oral pain medications before the block completely wears off (around 10-12 hours post-procedure) to stay ahead of pain 6.
Combine regional anesthesia benefits with regular acetaminophen and NSAIDs as prescribed for optimal multimodal analgesia 6.
Reserve opioids for rescue analgesia only if non-opioid medications are insufficient 6.
When to Contact Your Healthcare Provider
Non-Emergency Concerns
Contact your provider if you experience incomplete pain relief requiring supplementation, which occurs in approximately 2.8% of cases 1.
Report any concerns about block adequacy before surgery begins, as 2.6% of patients may require conversion to general anesthesia 1.
Notify your provider of any unexpected symptoms or concerns about recovery 1.
Special Considerations
Ultrasound Guidance Safety
Reassure patients that ultrasound guidance significantly improves safety, reducing complications like pneumothorax and allowing direct visualization of anatomical structures during needle placement 7, 3.
Ultrasound guidance reduces local anesthetic systemic toxicity risk by 50% and improves block success rates 6.
Anticoagulation Status
Patients must disclose all anticoagulant and antiplatelet medications, as active P2Y12 inhibitor therapy (clopidogrel, prasugrel, ticagrelor) is an absolute contraindication without appropriate discontinuation periods 4.
Therapeutic anticoagulation requires specific management protocols before the block can be safely performed 4.