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Local anes the tic

Figure 21.7d Ultrasound of anatomy and block needle of an infraclavicular brachial plexus block. Note the increased difficulty to easily image the block needle as well as some local anesthetic spread.

inserted with an in-plane approach (Figs. 21.7b and 21.7d). It is suggested to place two boluses of local anesthetic with one beside the lateral cord at the 9 o'clock position of the AA and the second injection posterior to the AA at the 6 o'clock position. Care must still be taken to avoid over insertion of the needle since the pleura can still lie within 8 cm or shallower, especially with more medial approaches.

An indwelling infraclavicular catheter may be easily inserted by placing the catheter tip just posterior to the AA followed by local anesthetic bolus and infusion (Fig. 21.7e). A complication of this PNB technique is the occurrence of a hematoma, and would be difficult to apply manual pressure. Other potential complications include pneumothorax (reduced risk

Figure 21.7e Ultrasound image of an infraclavicular indwelling catheter. Note the more hyperechoic local anesthetic solution surrounding the morehyperechoic nerve structures at the 3 o'clock position (medial cord), 6:30 position (posterior cord), and 8 o'clock position (lateral cord) around the axillary artery.

Figure 21.7e Ultrasound image of an infraclavicular indwelling catheter. Note the more hyperechoic local anesthetic solution surrounding the morehyperechoic nerve structures at the 3 o'clock position (medial cord), 6:30 position (posterior cord), and 8 o'clock position (lateral cord) around the axillary artery.

with proper technique), infection, local anesthetic toxicity, patient discomfort, neurologic injury, and failed block.

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