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INTERSCALENE BRACHIAL PLEXUS BLOCK AT A GLANCE
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Indications: shoulder and upper arm surgery, surgery of the clavicle (combined with cervical plexus block)
Transducer position: transverse on neck, 3–4 cm superior to clavicle, over external jugular vein (Figure 32B–1)
Goal: local anesthetic spread around superior and middle trunks of brachial plexus, between the anterior and middle scalene muscles
Local anesthetic: 7–15 mL
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GENERAL CONSIDERATIONS
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US guidance allows for visualization of the spread of the LA and additional injections around the brachial plexus if needed to ensure adequate spread of local anesthetic, improving block success. The ability to visualize local anesthetic spread and to inject multiple aliquots also allows for a reduction in the volume of local anesthetic required to accomplish the block.1,2
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The brachial plexus at the interscalene level is seen lateral to the carotid artery and internal jugular vein, between the anterior and middle scalene muscles (Figures 32B–2 and 32B–3). The prevertebral fascia, superficial cervical plexus, and sternocleidomastoid muscle are seen superficial to the plexus. The transducer is moved in the proximal-distal direction until two or more of the brachial plexus elements are seen in the space between the scalene muscles. Depending on the depth of field selected and the level at which scanning is performed, the first rib and/or the apex of the lung may be seen. The brachial plexus is typically visualized at a depth of 1–3 cm.
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