Plexus anesthesia: Interscalene, Subclavian and Axillary Perivascular Techniques

  • A. P. Winnie
Part of the Anaesthesiologie und Intensivmedizin Anaesthesiology and Intensive Care Medicine book series (A+I, volume 158)


The single-injection techniques developed to provide anesthesia for the upper extremities are based on the fact that all of the nerves to the arm are contained in a tubular sheath of fascia. [8,9,11] The anterior scalene muscle arises from the anterior tubercles of the transverse processes of the third, fourth, fifth, and sixth cervical vertebrae and inserts on the scalene tubercle of the first rib, separating the subclavian vein from the subclavian artery, which lies posterior to this insertion. The middle scalene muscle arises from the posterior tubercles of the transverse processes of the lower six cervical vertebrae. Its insertion is separated from that of the anterior scalene muscle by the subclavian groove, through which the artery passes. Thus, since the roots of the nerves comprising the brachial plexus travel in the groove between the anterior and posterior tubercles of the transverse processes of the cervical vertebrae, they emerge from the “gutters” of the cervical processes to descend toward the first rib between the two walls of fascia covering the anterior and middle scalene muscles (i.e., they enter the interscalene space). As the roots pass down through this space, they converge to form the trunks of the brachial plexus, which together with the subclavian artery invaginate the scalene fascia to form a subclavian perivascular sheath, which in turn becomes the axillary sheath as it passes under the clavicle.


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  1. 1.
    Aceardo NJ, Adxiani J (1949) Brachial plexus block: a simplified technic using the axillary route. South Med J 42: 920CrossRefGoogle Scholar
  2. 2.
    de Jong RH (1961) Axillary block of the brachial plexus. Anesthesiology 22: 215CrossRefGoogle Scholar
  3. 3.
    de Jong RH, Heavner JE (1971) Diazepam prevents local anesthetic seizures. Anesthesiology 34: 523PubMedCrossRefGoogle Scholar
  4. 4.
    de Jong RH, Wagman IH, Prince DA (1967) Effect of carbon dioxide on the cortical seizure threshold to lidocaine. Exp Neurol 17: 221PubMedCrossRefGoogle Scholar
  5. 5.
    Eriksson E (ed) (1969) Illustrated handbook of local anesthesia. Year Book Medical Publishers, Chicago, p 75Google Scholar
  6. 6.
    Eriksson E, Skarby HG (1962) A simplified method of axillary block. Nord Med 68: 1325Google Scholar
  7. 7.
    Kumar A, Battit GE, Froese AB et al. (1971) Bilateral cervical and thoracic epidural blockade complicating interscalene brachial plexus block. Anesthesiology 35: 650PubMedCrossRefGoogle Scholar
  8. 8.
    Labat G (1923) Regional anesthesia: its technic and clinical application, Saunders, PhiladelphiaGoogle Scholar
  9. 9.
    Moore DC (1971) Regional block. 9th edn. Thomas, SpringfieldGoogle Scholar
  10. 10.
    Moore DC (1969) Complications of regional anesthesia. In: Bonica JJ (ed) Regional anesthesia. Davis, Philadelphia, p 233Google Scholar
  11. 11.
    Pitkin GP (1953) Conduction anesthesia, 2nd ed. Lippincott, PhiladelphiaGoogle Scholar
  12. 12.
    Ross S, Scarborough CD (1973) Total spinal anesthesia following brachial plexus block. Anesthesiology 39: 458PubMedCrossRefGoogle Scholar
  13. 13.
    Winnie AP (1975) Regional anesthesia. Surg Clin North Am 54: 861Google Scholar
  14. 14.
    Winnie AP (1970) Interscalene brachial plexus block. Anesth Analg 49: 455PubMedCrossRefGoogle Scholar
  15. 15.
    Winnie AP (1969) An “immobile needle” for nerve blocks. Anesthesiology 31: 577PubMedCrossRefGoogle Scholar
  16. 16.
    Winnie AP, Collins VJ (1964) The subclavian perivascular technic of brachial plexus anesthesia. Anesthesiology 25: 353PubMedCrossRefGoogle Scholar
  17. 17.
    Winnie AP, Radonjic R, Akkineni SR, Durrani Z (1979) Factors influencing distrubution of local anesthetic injected into the brachial plexus sheath. Anesth Analg 58: 225PubMedGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1984

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  • A. P. Winnie

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