Peri-subclavian Artery Approaches

The brachial plexus trunks gather at the lower part of the interscalene space, where they surround the subclavian artery. They can be approached by several insertion routes derived from the original technique by Kulenkampf and Persky,^[227] which consists of penetrating the interscalene space slightly above the first rib. All these techniques are very effective on virtually all branches of the brachial plexus, but they require considerable experience on the part of the anesthesiologist, especially when performing these blocks in young children because they can result in severe complications, particularly pneumothorax, undesirable nerve blocks, and subclavian vessel puncture. They cannot be considered as safe techniques and should have no place in routine pediatric practice, at least in children younger than 10 years.