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Supraclavicular Nerve Block Medication

  • Author: Alma N Juels, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
 
Updated: Mar 27, 2014
 

Medication Summary

The goals of pharmacotherapy are to minimize pain, reduce morbidity, and prevent complications.

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Local Anesthetics, Amides

Class Summary

Local anesthetics are used for local pain relief.

Mepivacaine (Polocaine, Carbocaine)

 

For surgical anesthesia in adults, a single shot of 30 mL of 1.5% mepivacaine plain provides close to immediate (5 min) to 2-3 hrs of surgical analgesia. For longer surgical anesthesia up to 3-4 hrs, 1:400,000 epinephrine is added to the solution. The block completely resolves about 2 hrs later. If a longer block is needed, adding Tetracaine at 2mg/mL (0.2%) prolongs the block to 4-6 hrs.

For longer postoperative analgesia, 0.25% Ropivacaine or Bupivacaine is used and should provide more than 12 hr of pain relief. The onset is delayed from 5 min to about 20 min. This can be used for both perioperative and postoperative pain control. A combination of both can be used.

Mepivacaine with or without epinephrine decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses. Epinephrine prolongs the duration of the anesthetic effects from bupivacaine by causing vasoconstriction of the blood vessels surrounding the nerve axons.

Tetracaine

 

Tetracaine decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses. This agent is an option for longer if a longer block is needed.

Ropivacaine (Naropin)

 

Ropivacaine decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses. This agent is an option for longer postoperative analgesia.

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Contributor Information and Disclosures
Author

Alma N Juels, MD Assistant Clinical Professor, Department of Anesthesiology, University of Colorado Health Sciences Center; Attending Physician, Department of Anesthesiology, Denver Health and Hospital

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Meda Raghavendra (Raghu), MD Associate Professor, Interventional Pain Management, Department of Anesthesiology, Chicago Stritch School of Medicine, Loyola University Medical Center

Meda Raghavendra (Raghu), MD is a member of the following medical societies: American Society of Anesthesiologists, American Society of Regional Anesthesia and Pain Medicine, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

References
  1. http://www.usra.ca.

  2. http://www.nysora.com.

  3. http://web.squ.edu.om/med-Lib.

  4. http://neuraxiom.com/html/supraclavicular.html.

 
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Brachial plexus anatomy.
Nerve branches.
Supraclavicular nerve block.
Correct head position, transducer position, and in-plane needle insertion. Reproduced with permission.
White box is area scanned; SA=subclavian artery, SV=subclavian vein, SAM=scalenus anterior muscle, SMM=scalenus medius muscles, C=clavicle. Reproduced with permission.
Arrows=needle placement in-plane; arrowheads=brachial plexus nerves; SA=subclavian artery. Reproduced with permission.
 
 
 
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