infraclavicular

Treatment:

Complications:

after hand and wrist surgery, fewer patients with an infraclavicular block had pain (VAS >3) on arrival at the PACU (3%) compared with those who had received general anesthesia (43%). None of the patients who had received regional anesthesia requested treatment for pain while in the hospital, compared with 48% of patients in the general anesthesia group (1,2).
Four cases of neurological injury were detected in 627 infraclavicular nerve blocks (<1%), but there was a complete resolution of symptoms in each case (1,2).
Similar to the interscalene and supraclavicular approaches, reduced or paradoxical ipsilateral hemidiaphragmatic movement vas observed (26% of 35 patients) and Horner's syndrome was seen (12% of 35 patients) (1,3).
Using the nerve stimulation technique, vascular puncture was described with an incidence of 6.6% (1). Arterial punctures occurred in 0.7% of patients (all were inconsequential; the needle was withdrawn and reinserted in all of these patients to complete the block; none of these patients had any short- or long-term problems) (1,4).

Future risks:

for ambulatory surgery, the time to meet discharge criteria and actual discharge time were shorter for patients with infraclavicular nerve blocks compared with those in the general anesthesia group. In addition, significantly more outpatients who received infraclavicular plexus block met the criteria to bypass the PACU (1,2).

References:

J. Kessler et al. Peripheral regional anaesthesia and outcome: lessons learned from the last 10 years. British Journal of Anaesthesia. 2015;114(5):728-45: full text | pdf.
Hadzic A et al. A comparison of infraclavicular nerve block versus general anaesthesia for hand and wrist day-case surgeries. Anesthesiology. 2004;101:127-32: full text.
Rettig HC et al. Vertical infraclavicular block of the brachial plexus: effects on hemidiaphragmatic movement and ventilatory function. Reg Anesth Pain Med. 2005;30:529-35.
Sandhu NS et al. Sonographically guided infraclavicular brachial plexus block in adults: a retrospective analysis of 1146 cases. J Ultrasound Med. 2006;25:1555-61: full text | pdf.