George A. Anastasian, MD
Regional Anesthesia Fellow 2006-2007
Supraclavicular Blocks are often used to provide anesthesia for surgery on the shoulder or arm. This block is commonly performed at HSS with ultrasound guidance. This is a newer technique that has been shown to be safe and effective and is rapidly gaining popularity.
Once you arrive in the operating room the anesthesiologist will apply sedation before performance of the block. This will help relieve you of anxiety and will likely cause you to have no recollection of the effects of the block. Next, monitors such as electrocardiogram (EKG) “stickers” will be applied to your chest. A blood pressure cuff will be placed and a measurement taken. Oxygen will be supplied to your nose, and a light sensor will be placed on a finger to measure your oxygen level.
An antiseptic solution will then be applied to the area above your collarbone on the side of the surgery. You will be asked to turn your head to the other side as ultrasound gel and an ultrasound probe are placed in the area. This is to help the anesthesiologist see the nerves they will inject local anesthetic around. You will be warned and may feel a slight pinch as a very thin needle is inserted into the area above your collarbone. Shortly thereafter, your shoulder or arm will begin twitching involuntarily. This is not painful, and as mentioned before, you will most likely not remember this process at all.
The anesthesiologist will then inject a novocaine-like medicine, or local anesthetic, to make your shoulder and arm numb for the surgery. The needle is removed at the completion of the injection and the ultrasound gel is wiped off the area. As your arm is getting numb, a process that takes several minutes, the surgeons will be positioning and cleaning your arm. You will likely not be able to move your arm at this time. You will be given additional sedation prior to the start of surgery.
After the surgery the numbness and immobility lasts anywhere from 4 to approximately 18 hours, depending on which local anesthetics are used. Your voice may be a little hoarse and you may not be able to breathe as deeply on the side of the surgery. These are normal experiences, and they will disappear as the block wears off.
As with any anesthetic, there are risks and benefits to supraclavicular blocks. These particulars can be discussed with your anesthesiologist before your surgery.