Pain Management Procedures
Upper-Extremity Brachial Plexus Blocks
Upper-Extremity Brachial Plexus Blocks
What are they?
The brachial plexus is the network of nerves that supplies the shoulder, arm, and hand. Different approaches target it at different locations: interscalene in the side of the neck, supraclavicular above the collarbone, and infraclavicular below it. These blocks are best known for surgical anesthesia and postoperative pain control but may be used for selected pain conditions.
How do the approaches differ?
· Interscalene block mainly covers the shoulder and upper arm. It commonly affects the phrenic nerve and can temporarily reduce movement of one side of the diaphragm.
· Supraclavicular block gives dense coverage of much of the arm and hand but is performed near the lung.
· Infraclavicular block targets the nerve cords below the collarbone and is farther from the lung than the supraclavicular approach, though major blood vessels remain nearby.
What happens?
Standard monitoring and ultrasound are used. After sterile preparation, the needle is guided beside the nerve bundle and local anesthetic is injected while its spread is watched. The arm becomes numb and weak. The exact approach depends on the painful area, medical history, and breathing risk.
What should I expect?
Protect the numb arm in a sling if instructed and avoid heat, pressure, driving, or machinery until strength and sensation return. Hoarseness, droopy eyelid, or a sensation of mild shortness of breath can occur with proximal blocks.
Important risks
All approaches can cause bleeding, infection, nerve injury, or local-anesthetic toxicity. Interscalene block can significantly affect breathing and may not be appropriate for patients with limited lung reserve. Supraclavicular block carries a pneumothorax risk. Seek urgent care for breathing difficulty, seizure, fainting, or symptoms of a severe medication reaction.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.