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January 1965

Block of the Upper Extremity: Supraclavicular Approach Versus Axillary Approach

Author Affiliations

From the Mason Clinic and the Children's Orthopedic Hospital and Medical Center.

Arch Surg. 1965;90(1):68-72. doi:10.1001/archsurg.1965.01320070070015

PRIOR TO 1959, the supraclavicular approach was the acceptable and usual method employed for executing a nerve block of the upper extremity. Since 1959, many articles have appeared extolling the advantages of the axillary approach as compared to the supraclavicular.1-12 The present emphasis implies that the axillary approach will permit manipulations of and operations on the upper extremity to the same extent as the supraclavicular approach without the added risk of a pneumothorax. While, from an academic standpoint, this concept may be valid, it is misleading. In a clinical practice where many variables exist (skill of the physician, physical status of the patient, area of operation, etc) and where an upper extremity block is indicated, these two approaches are not interchangeable in all cases.

The purpose of this paper is to: (1) review and analyze the blocks of the upper extremity performed by us and our residents from Jan