Education  |   October 2017
Costoclavicular Space: A Reliable Gate for Continuous Regional Anesthesia Catheter Insertion
Author Notes
  • From the Departments of Anesthesiology and Intensive Care (C.G.-V., M.B.) and Radiology (J.V.), Hospital Universitari Doctor Peset, Valencia, Spain; and Department of Anesthesiology and Intensive Care, Hospital Intermutual de Levante, Valencia, Spain (A.M.L.N.).
  • Address correspondence to Dr. García-Vitoria: carlesgvitoria@gmail.com
Article Information
Education / Images in Anesthesiology / Regional Anesthesia
Education   |   October 2017
Costoclavicular Space: A Reliable Gate for Continuous Regional Anesthesia Catheter Insertion
Anesthesiology 10 2017, Vol.127, 712. doi:10.1097/ALN.0000000000001724
Anesthesiology 10 2017, Vol.127, 712. doi:10.1097/ALN.0000000000001724
CONTINUOUS ultrasound-guided brachial plexus blocks are indicated for pain control and rehabilitation after hand and elbow surgery.1  The traditional supraclavicular approach implies a high risk of accidental catheter displacement. We describe an approach to the supraclavicular region through the costoclavicular space.2,3 Figure 1 shows a reconstructed image of a catheter placed using this technique with its entry point (blue arrow) and tip position (yellow arrow) marked.
As seen in figure 2, the needle is introduced 5 cm caudal to the clavicle, and its tip (white arrow) is advanced in-plane within the pectoralis major muscle, pointing to the subclavian muscle (green arrow) and the entry of costoclavicular space (red line). Once the tip view is lost under the clavicular anechoic shadow, a supraclavicular plexus image is obtained, and the needle is advanced out-of-plane, rubbing the clavicular periosteum, toward the “corner pocket.” The needle tip finally appears as a hyperechoic dot in the ultrasound image, and the catheter is advanced and left in place: figure 3 shows catheter tip (arrow) lateral to subclavian artery and surrounded by supraclavicular brachial plexus (shaded in green with “corner pocket” shaded in orange).
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