"Place a skin wheal at site of insertion with 30-gauge needle. Using an in-plane technique with the probe marker directed toward patient midline, the needle is inserted parallel to the ultrasound beam. The needle is advanced through the middle scalene muscle under real-time guidance until just short of the interscalene groove. The needle is then advanced into the groove with hydrodissection, and circumferential spread of local anaesthetic should be achieved, requiring roughly 10-20 mL of lidocaine (higher volume block)."
"Ultrasound-guided brachial plexus nerve blocks entered the literature in 1989, when Ting et al. detailed their success with axillary nerve blocks in 10 patients 3."
"The transducer should be moved laterally, to the edge of the sternocleidomastoid. The sternocleidomastoid's clavicular head may be identified superficially, as well as the deeper anterior and middle scalenes. Three hypoechoic structures may then be visualised in the interscalene groove, representing the C5-C7 roots."
Expected headings
"History"
"Preprocedural evaluation"
"Positioning/room set up"