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Supraclavicular Brachial Plexus Block

Ultrasound-guided approach at the trunk/division level for elbow, forearm, and hand surgery

Ultrasound-guided supraclavicular brachial plexus block for elbow, forearm, and hand surgery; pneumothorax occurs in 0.5-6% and is not eliminated by ultrasound, while higher local-anesthetic volumes can cause phrenic nerve blockade.

If you forget

Headline: continuous needle-tip visualization is the safety rule

Board trap
Ultrasound does NOT eliminate pneumothorax risk in supraclavicular blocks; the examiner will probe for contralateral phrenic nerve injury (phrenic block here can precipitate respiratory failure) and ask why you limit volume to ≤15 mL.

Key numbers

  • Pneumothorax incidence after supraclavicular block: 0.5-6%
  • Local anesthetic volume per injection: 5-15 mL; total volume ≤15 mL limits phrenic nerve blockade
  • Mepivacaine suitable for procedures up to 2 hours; ropivacaine or bupivacaine preferred for procedures >2 hours
  • Intraneural stimulation threshold >0.5 mA occurred in 10% of adult patients with intraneural needle placement
Reviewed Oct 8, 2026 for clinical accuracy by BoardsBridge Editorial Process

Uri Rozen, MD — Licensed Physician, Israel

Source guidelines: Millers Anesthesia 10 Ch42 Peripheral Nerve Blocks AND Ultrasound Guidance FOR Regional · SVS Perioperative Vascular Care 2022 · Millers Anesthesia 10 Ch74 Regional Anesthesia IN Children

Re-review cadence: 12 months from reviewed date.

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Related on BoardsBridge

Card ID: supraclavicular · Path: aba.regional.upper-extremity.supraclavicular

Educational reference only. Reviewed for clinical accuracy against current authoritative guidelines. Not a substitute for clinical judgment. See editorial process and the sitemap entry for this card.