Sonoanatomy of the Nerves Below the Clavicle

The area below the clavicle is where an infraclavicular block is typically performed. Although a very popular and useful approach for single injection nerve blocks for regional anesthesia, infraclavicular blocks have been met with disappointment as far as continuous nerve blocks are concerned. The most likely reason is probably because infraclavicular blocks are usually performed in the area of the deltopectoral groove, where the three cords are arranged around the axillary artery and are relatively far apart. A better option for continuous nerve block catheter placement would probably be more proximal, directly under the clavicle, where all three the cords are together just after crossing the first rib with the vein most medial, the artery more lateral, and the bundle of brachial plexus cords most lateral (very similar to the femoral nerve). This chapter outlines these differences ultrasonographically. The ultrasoundassisted approach to the lateral and medial pectoral nerves, the so-called “PEC 1” block,” is also discussed. The proximal and distal infraclavicular nerves, as well as the pectoralis approach to the lateral and medial pectoral muscles, are discussed in this chapter with the help static images and video productions.

Keywords: Acute pain medicine, Axillary artery, Axillary vein, Brachial plexus, Brachial plexus cords, Continuous infraclavicular block, Continuous nerve blocks, Deltopectoral groove, Distal infraclavicular nerve, Dynamic ultrasound, First rib, Infraclavicular block, Lateral cord, Lateral pectoral nerve, Medial cord, Medial pectoral nerve, PEC 1 block, Pectoralis approach, Posterior cord, Proximal infraclavicular nerves, Regional anesthesia, Static ultrasound.