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The supraclavicular nerve is a cutaneous (sensory) nerve of the cervical plexus that arises from the third and fourth cervical (spinal) nerves. It emerges from beneath the posterior border of the sternocleidomastoid muscle, then split into multiple branches. Together, these innervate the skin over the shoulder.
However, a recent study using ultrasound to follow the spread of local anesthetic demonstrated an improved success rate of the block (relative to blocks done with nerve stimulator alone) even at the inferior roots of the plexus. [2] For supraclavicular block, nerve stimulation with a minimal threshold of 0.9 mA can offer a dependable block. [11]
Nerve block or regional nerve blockade is any deliberate interruption of signals traveling along a nerve, often for the purpose of pain relief. Local anesthetic nerve block (sometimes referred to as simply "nerve block") is a short-term block, usually lasting hours or days, involving the injection of an anesthetic, a corticosteroid, and other agents onto or near a nerve.
Kehr's sign is a classic example of referred pain: irritation of the diaphragm is signaled by the phrenic nerve as pain in the area above the collarbone. This is because the supraclavicular nerves have the same cervical nerves origin as the phrenic nerve, C3, C4, and C5. [citation needed]
Supraclavicular nerves (yellow) Axillary nerve (blue). Also Superior lateral cutaneous nerve of arm. Inferior lateral cutaneous nerve of arm - Near blue "axillary" area, but actually branches from radial nerve. Most modern sources distinguish the superior and inferior, but some still include a single "lateral brachial cutaneous nerve".
This procedure is typically performed under general anesthesia but can be performed under supraclavicular brachial plexus blockade. The incision depends on whether there is a contracture that needs to be released. If this is the case a wide exposure of the anterior side of the elbow joint is needed.
The patient would be unable to pull their shoulder back, as when standing at attention. Isolated dorsal scapular nerve injury is uncommon, but case reports usually involve injury to the scalene muscles. [5] The dorsal scapular nerve is typically not anaesthetised during a supraclavicular nerve block. [6] This can cause pain after some surgeries ...
In cases where the first rib (or a fibrous band extending from the first rib) is compressing a vein, artery, or the nerve bundle, part of the first rib and any compressive fibrous tissue, can be removed in a first rib resection and thoracic outlet decompression surgical procedure; scalene muscles may also need to be removed (scalenectomy).