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Copyright (c) 2026 Iskandar Khalid, Shahridan Mohd Fathil, Jatuporn Pakpirom
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Abstract
The supraclavicular brachial plexus block remains a reliable and time-efficient technique for surgical anaesthesia and postoperative analgesia for upper limb procedures. Ultrasound guidance has improved visualisation of the plexus,
subclavian vessels, first rib and pleura, but clinically important risks persist, including pneumothorax, vascular puncture, local anaesthetic systemic toxicity, nerve injury and hemidiaphragmatic paresis. Contemporary practice has moved beyond the traditional cluster injection toward more anatomy-directed strategies. Corner pocket and intertruncal approaches aim to improve coverage of the inferior trunk and the ulnar nerve, while selective trunk and superior trunk blocks allow more tailored sensory profiles for whole-limb or shoulder-focused indications. Continuous supraclavicular catheter techniques, including proximal longitudinal oblique approaches, may expand the role of supraclavicular blockade in shoulder analgesia while reducing, but not abolishing, diaphragmatic involvement compared with interscalene techniques. This narrative review summarises the relevant anatomy, historical evolution, named variants, clinical efficacy, complications, local anaesthetic strategies, adjuvants, and catheter techniques related to the supraclavicular brachial plexus block. It also proposes a practical decision-making framework to guide technique selection based on surgical site, need for ulnar coverage, anticipated duration of analgesia, pulmonary reserve, coagulation status, and patient-specific risk. Meticulous ultrasound technique, appropriate volume selection, as well as readiness to manage complications remain central to safe and effective practice.
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