Journal of Anesthesia

, Volume 33, Issue 3, pp 463–477 | Cite as

Infraclavicular brachial plexus block in adults: a comprehensive review based on a unified nomenclature system

  • An-Chih Hsu
  • Yu-Ting Tai
  • Ko-Huan Lin
  • Han-Yun Yao
  • Han-Liang Chiang
  • Bing-Ying Ho
  • Sheng-Feng Yang
  • Jui-An LinEmail author
  • Ching-Lung KoEmail author
Review Article


Over the last decade, considerable progress has been made regarding infraclavicular brachial plexus block (ICB) in adults, especially since the introduction of ultrasound guidance. The advancements in ICB have been attributed to the development of various approaches to improve the success rate and reduce complications. This has also necessitated a unified nomenclature system to facilitate comparison among different approaches. This review aimed to propose an anatomical nomenclature system by classifying ICB approaches into proximal and distal ones to aid future research and provide practice advisories according to recent updates. We also comprehensively discuss various aspects of this nomenclature system. Our review suggests that ultrasound-guided ICB should be categorized as an advanced technique that should be performed under supervision and dual guidance. For one-shot block, the conventional distal approach is still preferred but should be modified to follow ergonomic practice, with the arm in the proper position. For continuous ICB, the proximal approach is promising for reducing local anesthetic volume and increasing efficacy. Nevertheless, further studies are warranted in this direction. We provide practice advisories to maximize safety and minimize adverse events, and recommend designing future studies on ICB according to these findings based on the unified nomenclature system.


Brachial plexus block Infraclavicular Adult Terminology 



Financial support and sponsorship: This work was supported by Grants from Wan Fang Hospital, Taiwan (107-wf-eva-30), Hualien Armed Forces General, Hospital, Taiwan (805-C108-02), and Ministry of Science and Technology, Taiwan (MOST 106-2314-B-038-044). The authors thank Editage for providing editorial assistance.

Author contributions

The photos and ultrasound images were taken from the body of the authors.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interests.


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Copyright information

© Japanese Society of Anesthesiologists 2019

Authors and Affiliations

  1. 1.Department of Anesthesiology, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
  2. 2.Department of Anesthesiology, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
  3. 3.Division of PsychiatryHualien Armed Forces General HospitalHualienTaiwan
  4. 4.Department of Anesthesiology, School of Medicine, College of MedicineNational Defense Medicine CenterTaipeiTaiwan
  5. 5.Department of AnesthesiologyKaohsiung Veteran General HospitalKaohsiungTaiwan
  6. 6.Pain Research Center, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan

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