The application of infraclavicular brachial plexus block with retroclavicular approach for arterio-venous fistula aneurysm.

Abstract

Infraclavicular block provides adequate anesthesia to the arm, forearm, and antecubital region. There are many different approaches to infraclavicular brachial plexus block. Corocoid approach which is mostly preferred is not appropriate in some cases that needle orientation disappear. In this case report, we performed a newly defined retroclavicular approach to infraclavicular brachial plexus block and discussed in the light of information in literature. The patient who has 79 year old man, 29.36 body mass index, American Society of Anesthesiologists 3 with chronic renal failure was admitted to the operation room with complaint of aneurysmatic arteriovenous fistula in the left antecubital area. We planned the infraclavicular brachial plexus block with retroclavicular approach for better visibility of needle. The needle insertion point was posterior to the clavicle and the needle was advanced from cephalad to caudal. The block was effectuated after median nerve stimulation as the needle was advanced toward posterior of axillar artery. In our case with excess weight and life-threatening disease, it is highly reliable to perform infraclavicular block with retroclavicular approach indicated spread of local anesthetic, needle tip, and orientation without damage to nerve and vascular structures under ultrasound-guided.