Supine, head turned to opposite side. Posterior border of SCM identified at level of cricoid (C6) and a finger rolled to feel interscalene groove (anterior and medius). Needle advanced at 2mA, usually superficial.
Most procedures can be done by doing an interscalene block (proximal humerus and shoulder surgery) or an axillary block (elbow, forearm and hand procedures)
Can anaesthetise elbow, forearm and hand - similar indications to axillary nerve block
Medial approach
Needle inserted immediately below the midpoint of the clavicle. The needle is advanced in the ventral-dorsal plane only and never medially. Needle is moved caudally if the plexus is not encountered. Depth 2-4cm
Lateral approach
Needle inserted 2cm medial and 2cm inferior to the coracoid process at a depth of 2.5-7.5cm. Success rates low with single shot
Most descriptions use 30-40ml of LA with nerve stimulator or USS
Onset can be slow - up to 30 minutes
Characteristics of comparable nerve blocks
Supraclavicular
Reliably anaesthetises upper arm and forearm
Can be performed without moving the arm
Pneumothorax rate 0.5%
High rate of phrenic nerve palsy 25-50%
Axillary block
Safe, reliable rapid onset with US
Easy to learn
Technically difficult with limited shoulder abduction
Used for procedures involving the forearm and hand
Supine, head turned away. Arm abducted and flexed to 90 degrees. Axillary artery palpated and 3 injections made from 1 puncture. 20-25ml is usually adequate to perform the block