Block Efficacy Above the Clavicle: Volume of Local Anaesthetic Agents

Vol 2 | Issue 1 | January-June 2021 | Page 35-39 | T. Sivashanmugam, Archana Areti

Authors: T. Sivashanmugamb [1], Archana Areti [1]

[1] Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute,
Sri Balaji Vidyapeeth Deemed-to-be University, Puducherry, India.

Address of Correspondence

Dr. T. Sivashanmugam,
Professor, Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute,
Sri Balaji Vidyapeeth Deemed-to-be University, Puducherry, India.



The regional anaesthesiologist’s primary goal is to deposit adequate local anaesthetic (LA) in the vicinity of nerves for the desired effect without complications. Our inability to visualise nerves, during landmark and peripheral nerve stimulation techniques, was the biggest obstacle against accurate deposition. Ultrasound (US) guidance enables accurate deposition of local anaesthetics due to objective and consistent visualisation of target nerves [1]. However, the minimum effective local anaesthetic volume (MELAV) varies among clinicians. Stephan Kapral in 1994 described the first ultrasound-guided supraclavicular brachial plexus block [2]. However, the image quality and the injection technique similar to our present-day practice appeared in 2003, where Vincent Chan et al injected 40 ml of local anaesthetic (LA) volume to achieve a 95% success rate [3]. This article reviews the studies that explored the MELAV for US-guided brachial plexus blocks (BPB) above the clavicle and explores the possible reasons for variations reported by authors and to direct future research for identification of safe and effective local anaesthetic volume for the BPB above the clavicle.


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2. Kapral S, Krafft P, Eibenberger K, Fitzgerald R, Gosch M, Weinstabl C. Ultrasound-Guided Supraclavicular Approach for Regional Anesthesia of the Brachial Plexus: Anesthesia & Analgesia. 1994 Mar;78(3):507-513.
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How to Cite this Article: Sivashanmugam | Block Efficacy Above the Clavicle: Volume of Local Anaesthetic Agents | International Journal of Regional Anaesthesia | January-June 2021; 2(1): 35-39.

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