Use of 25 ml 0.5% Ropivacaine via Retroclavicular Approach

Classic Coracoid Infraclavicular Block with 25 ml 0.5% Ropivacaine

The retro clavicular approach to the Infraclavicular brachial plexus block will be performed by placing probe parasagittally just medial to the coracoid process and caudal from the clavicle. The needle insertion point was located in the supraclavicular fossa, just medial to the shoulder at a point sufficiently posterior to the clavicle and medial to the trapezius muscle insertion point on the clavicle. The needle will be inserted immediately above the clavicle in the space between the coracoid process and the clavicle and advanced from cephalad to caudal.

Onset of motor block assess using modified bromage scale

Score Grade of motor blockade(Modified bromage scale) 0 Normal muscle function with full range of movement of elbow, wrist and fingers .

1 Decreased muscle power so that patient can move fingers and /or wrist only 2. Complete loss of muscle function with no movement in fingers/wrist

Onset of sensory block assess using pin prick method Grade of sensory blockade Score

1. Feeling sharp pinprick (no block) 0
2. Blunt sensation on pinprick (partial block 1
3. No sensation on pinprick (complete block) 2

Block adequate for surgery when there is no need for local infiltration and general anesthesia

NEEDLE SHADOW VISIBILITY 5-POINT LIKERT SCALE SCORE Needle tip visibility

1. Very poor
2. Poor
3. Fair
4. Good
5. Very good

5-POINT LIKERT SCALE SCORE Needle Shaft visibility

1. None of the shaft visualized
2. Only a small segment of the shaft visualized
3. Less than half of the shaft visualized
4. Almost all of the shaft visualized
5. The entire shaft visualized

Rescue anesthesia given when block is not adequate for surgery such as local infiltration and general anesthesia