Bloqueo del

plexo braquial
infraclavicular
Dumar Sebastian Corredor Rodriguez
Residente de 2do año anestesiologia - HGT
 Contenido
Historia

Anatomia

Tecnica del bloqueo

Sonoanatomia

Dosis y complicaciones

Revision de articulos
 Hirschel
1911 Abordaje axilar AL superior 1ra
Costilla
Bloqueo incompleto

Kulenkampff
Historia 1911 Describe la tecnica, mas segura

Bazy
1914 Abordaje medial, menos lesiones
pleurales

Bloqueo del plexo braquial infraclavicular, Laura Lowrey Clark, MD, Capitulo 27, Tratado de anestesia regional y manejo
del dolor agudo, Admir Hadzic, edición español 2010
 Babitszky, Balog
1911-1919 Interseccion 2da costilla y clavicula
Golpear la 2da costilla
5 ml a 20 ml

Raj
Historia 1973 Linea media y lateral
Neuroestimular – No fue popular por
tecnica

Sims
1977 Abordaje medial, menos lesiones
pleurales

Bloqueo del plexo braquial infraclavicular, Laura Lowrey Clark, MD, Capitulo 27, Tratado de anestesia regional y manejo
del dolor agudo, Admir Hadzic, edición español 2010
 Whiffler
1981 Bloqueo coracoideo
Similar a Sims, diferia posición
paciente

Raj
Historia 1990 Modificado - pulsacion art subclavia
y humeral a 2.5 cm infraclavicular

Klaastad
1999 Estudio RMN del bloqueo

Bloqueo del plexo braquial infraclavicular, Laura Lowrey Clark, MD, Capitulo 27, Tratado de anestesia regional y manejo
del dolor agudo, Admir Hadzic, edición español 2010
Anatomia
 Anterior Medial
Ms serrato anterior y
Pectoral menor y mayor costillas

Superior
Clavicula Lateral
Coracoides Humero

Hadzic`s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia, third edition, chapther 15
Hadzic`s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia, third edition, chapther 15
Hadzic`s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia, third edition, chapther 15
Distribución de Anestesia y Analgesia

Hadzic`s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia, third edition, chapther 15
 Indicaciones

Brazo Codo-Antebrazo Mano

Hadzic`s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia, third edition, chapther 15
 Contraindicaciones

Absolutas Relativas

• Paciente no cooperador o agitado

• Paciente no quiera
• Historia de alergia AL no
• Alergia documentada AL
documentada
• Trauma o neuropatía del nervio o
• Historia de déficit neurológico a lo
plexo
largo distribución del bloqueo
• Coagulopatía bloqueo profundo,
• Coagulopatía o uso de
especialmente centrales
anticoagulantes para bloqueos
• Infección sitio de punción
periféricos perivasculares

Hadzic`s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia, third edition, chapther 7
 Consideraciones generales
USG
No lesión nervio frenico Vision directa distribucion
del AL

No requiere
posicionamiento de la Sagital lateral clasico por el
extremidad sin USG retroclavicular

Exito porcion infraclavicular

axillar
Identificar los 3 cordones

Hadzic`s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia, third edition, chapther 15
 Limitaciones

Obesidad Fisiculturistas

Se debera realizar enfoque proximal (

supraclavicular) o distal (axillar)

Hadzic`s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia, third edition, chapther 15
 Ventajas Desventajas

• Colocación de catéter • No adecuada imagen USG en

• Menor incidencia bloqueo nervio obesos
frénico • Bloqueo profundo
• Menor riesgo de neumotórax que el • Requiere altos volúmenes para
bloqueo supraclavicular bloquear 3 cordones
• Bloqueo intercostobranquial pudiese
ser necesario

Hadzic`s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia, third edition, chapther 7
 Riesgos especificos
Pleural
Neumotorax

Vascular
Diseccion de la arterial axilar

Hadzic`s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia, third edition, chapther 15
SONOANATOMIA
Hadzic`s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia, third edition, chapther 15
Hadzic`s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia, third edition, chapther 15
 Respuesta neuroestimulador
Cordon lateral

https://userscontent2.emaze.com/images/9cdec22c-e719-4753-b06d-4a5ec1bb8e92/a021f6f3-c122-4441-bfbe-3903f86749f7
Respuesta neuroestimulador
Cordon posterior

https://i.ytimg.com/vi/-HpBF3oAi9w/maxresdefault.jpg
Preparacion
• Transductor: Linea alta frecuencia
• Aguja: 50 – 100 mm, 22 G, bisel croto, aguja estimulante

Hadzic`s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia, third edition, chapther 15
 DOSIS
• Abordaje paracoracoideo
20 – 30 ML
• Acción corta: Lidocaína 2%
• Lido 18 ml (2%) + Sulf Mg 2ml (50%)+ Sol
salina 10 ml
• Acción prolongada:
• Bpv 0.5%, Lvp 0.5%, Rpv 0.5%

Hadzic`s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia, third edition, chapther 15
The Effects of Magnesium Sulfate with Lidocaine for Infraclavicular Brachial Plexus Block for Upper Extremity Surgeries, J Brachial Plex Peripher Nerve Inj 2020;15:e33–e39.
DOI https://doi.org/ 10.1055/s-0040-1715578.
Hadzic`s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia, third edition, chapther 15
Hadzic`s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia, third edition, chapther 15
Técnica alternativa
Hadzic`s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia, third edition, chapther 15
 Consejos para resolver problemas
USG Aspirar
1 4
Girar orientacion oblicua
Imagen transversa art y Cada 3 a 5 ml
cordones

Doppler Objetividad
2 5
Asegurar distribucion del AL
Antes de insercion,
Asegurar bloque cordon
identificar vasos vecinos
medial

Aguja Maniobra talon-punta

3 6
Longitud adecuada Insercion de aguja cuando
Ecogenicas clavicula obstruye

Hadzic`s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia, third edition, chapther 15
Hadzic`s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia, third edition, chapther 15
Revision articulos
 13652044, 2018, 10, Downloaded from https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.14360 by Universidad Nacional Autonoma De Mexico, Wiley Online Library on [26/02/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.co
Anaesthesia 2018, 73, 1251–1259 doi:10.1111/anae.14360

Original Article

Effect of a lateral infraclavicular brachial plexus block on

the axillary and suprascapular nerves as determined by
electromyography – a cohort study
C. Steen-Hansen,1 C. Rothe,1 K. H. W. Lange2 and L. H. Lundstrøm2

1 Resident, 2 Consultant and Associate Professor, Department of Anaesthesiology, Nordsjællands Hospital,

University of Copenhagen, Denmark

Summary
We aimed • Observacional
to examineMayo 2016extent
to what – Junio a
2017
lateral infraclavicular brachial plexus block affected the axillary and
• 20 pacientes sometidos a cirugia mano
the suprascapular
Estudio nerve. We included patients undergoing hand surgery anaesthetised with a lateral infra-
clavicular brachial plexus block. Our primary outcome was the relative change in surface electromyography
during maximum voluntary isometric contraction of the medial deltoid muscle (axillary nerve) and the
infraspinatus muscle (suprascapular nerve) from baseline to 30 min after the block procedure. A reduction
in electromyography of > 50% defined a successful block. The impact of the block on the shoulder nerves
• En qué medida un bloqueo del plexo braquial infraclavicular lateral afectaba al nervio axilar y supraescapular
was compared with the surgical target nerves of the arm and hand (musculocutaneous, radial, median and
Objetivo
ulnar nerves). Twenty patients were included. The medians of the relative changes in the surface electro-
myography were significantly reduced (both p < 0.001) with 92% for the deltoid muscle and 30% for the
infraspinatus muscle, respectively. In total, 18 out of 20 patients had reductions > 50% for the deltoid
• Cambio EMG Ms deltoides medial (N. axilar) y Ms infraespinoso (N. supraescapular)
muscle, which was significantly different from the infraspinatus muscle, where the proportion was 5 out of
• Reducción EMG de > 50% definió un bloqueo exitoso
20 (p < 0.001). The medians of the relative reductions in electromyography for the arm and hand muscles
• Medicion T0 y T30
were 90–96%, similar to the effect on the deltoid muscle. Our results suggest that a lateral infraclavicular
Resultado • RPV 7.5 %, volumen de 20 ml
block provides block of the axillary nerve comparable to the block of the surgical target nerves. The
suprascapular nerve is blocked to a lesser degree. Combining a lateral infraclavicular brachial plexus block
with a selective suprascapular block for shoulder surgery warrants further studies.

.................................................................................................................................................................
Correspondence to: C. Steen-Hansen
Email: christian@steen-hansen.dk
 N. • Rotacion
externa del
supraescapular hombro

• Abduccion
N. axilar del hombro

N. mscutaneo • Flexion del

codo

• Extension de
Sensación térmica
N. radial muñeca

• Abduccion
N. mediano del pulgar

N. cubital • Extension
dedo 2 y 5
• Argumento más importante: preservación del nervio frénico
• Musso et al. utilizaron una combinación de un bloqueo del plexo cervical superficial, un bloqueo del nervio supraescapular y un
bloqueo del plexo braquial infraclavicular en 20 pacientes sometidos a cirugía artroscópica de hombro. En 19 de los 20
pacientes, la operación se llevó a cabo