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

Abstract

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.

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Acknowledgements

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.

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Correspondence to Jui-An Lin or Ching-Lung Ko.

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Hsu, AC., Tai, YT., Lin, KH. et al. Infraclavicular brachial plexus block in adults: a comprehensive review based on a unified nomenclature system. J Anesth 33, 463–477 (2019). https://doi.org/10.1007/s00540-019-02638-0

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Keywords

  • Brachial plexus block
  • Infraclavicular
  • Adult
  • Terminology