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Chapter 31C. Ultrasound-Guided Supraclavicular Brachial Plexus Block
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Regarding anatomy, which of the following statements is correct?
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A. The block is performed where divisions are formed from the trunks.
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B. The dorsal scapular artery crosses posterior to the middle scalene muscle.
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C. The subclavian artery passes anterior to the anterior scalene muscle.
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D. The superficial and lateral branches come from C8 and T1.
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A is correct. Because the trunks and divisions of the brachial plexus are relatively close as they pass over the first rib, the extension and quality of anesthesia are favorable.
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B is incorrect. The dorsal scapular artery is often seen within the plexus
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C is incorrect. The subclavian artery passes between anterior and middle scalene muscle.
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D is incorrect. The superficial and lateral branches come from C5 to C7.
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Regarding ultrasound appearance, which of the following statements is correct?
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A. The brachial plexus is seen as a hypoechoic structure deep to the artery.
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B. The brachial plexus is typically visualized at a 1–3 cm depth.
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C. The first rib is seen as a hyperechoic line with acoustic enhancement.
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D. The pleura is seen as a hyperechoic static line.
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B is correct. See Figure 31C–1.
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A is incorrect. The brachial plexus is seen as a hypoechoic structure posterior and superficial to the artery.
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C is incorrect. The rib casts an acoustic shadow. Acoustic enhancement can be seen deep to the vascular structures.
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D is incorrect. Typical for the pleura is the dynamic sliding motion of the visceral pleura in synchrony with the patient’s respiration.
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Regarding distribution, which part of the arm is never anesthetised by a supraclavicular block?
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C. Skin of the proximal part of the medial side of the arm
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