• An-Chih Hsu, Yu-Ting Tai, Ko-Huan Lin, Han-Yun Yao, Han-Liang Chiang, Bing-Ying Ho, Sheng-Feng Yang, Jui-An Lin, and Ching-Lung Ko.
• Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
• J Anesth. 2019 Jun 1; 33 (3): 463-477.

AbstractOver the last decade, considerable progress has been made regarding infraclavicular brachial plexus block (ICB) in adults, especially since the introduction of ultrasound guidance. The advancements in ICB have been attributed to the development of various approaches to improve the success rate and reduce complications. This has also necessitated a unified nomenclature system to facilitate comparison among different approaches. This review aimed to propose an anatomical nomenclature system by classifying ICB approaches into proximal and distal ones to aid future research and provide practice advisories according to recent updates. We also comprehensively discuss various aspects of this nomenclature system. Our review suggests that ultrasound-guided ICB should be categorized as an advanced technique that should be performed under supervision and dual guidance. For one-shot block, the conventional distal approach is still preferred but should be modified to follow ergonomic practice, with the arm in the proper position. For continuous ICB, the proximal approach is promising for reducing local anesthetic volume and increasing efficacy. Nevertheless, further studies are warranted in this direction. We provide practice advisories to maximize safety and minimize adverse events, and recommend designing future studies on ICB according to these findings based on the unified nomenclature system.

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