Preparation
ECG monitoring, venous access, oxygen inhalation and sedation.
Disinfect the puncture site 3 times and spread towels.
Methods
Intermuscular groove approach
Indications: Anesthesia and analgesia for shoulder, distal clavicle and proximal humerus surgery.
Position: Lie on your back and turn your head to the opposite side, with a small pillow under your shoulders.
Block needle: 5cm&22G short bevel block needle
Ultrasound probe: high frequency linear array probe
Ultrasound technology: In-plane technology is often used to insert the needle from the outside to inject the local anesthetic into the intermuscular groove.
Local anesthetic: 10-15ml
The ultrasound probe is initially placed on the external jugular vein about 3 cm above the clavicle, or scanning from the supraclavicular fossa to the side of the head.
Several circular hypoechoic structures arranged obliquely between the anterior and middle scalene muscles are the brachial plexus nerve roots or nerve trunks. Tracing the head to the transverse groove of the cervical spine can identify the source of the nerve roots or nerve trunks.
Supraclavicular approach
Indications: Surgical anesthesia and analgesia of the humerus, elbow, forearm and hand.
Position: supine or semi-sitting position, head turned to the opposite side, a small pillow can be placed under the shoulders.
Block needle: 5cm&22G short bevel block needle
Ultrasound probe: high frequency linear array probe
Ultrasound technology: In-plane technology is often used to insert the needle from the outside to the inside, and the local anesthetic is injected into the brachial plexus sheath.
Local anesthetic: 20-25ml
The ultrasound probe is initially placed in the supraclavicular fossa and tilted caudally.
The upper and outer honeycomb structure of the subclavian artery is the assembled brachial plexus.
Subclavian approach
Indications: Surgical anesthesia and analgesia of the humerus, elbow, forearm and hand.
Position: Lie on your back with your upper arms abducted and your elbows flexed.
Block needle: 10cm&22G short bevel block needle
Ultrasound probe: high frequency linear array probe
Ultrasound technology: In-plane technology is often used to insert the needle from the head side to the caudal side, and out-of-plane technology can also be used. The local anesthetic is injected around the axillary artery in a U shape around the axillary artery.
Local anesthetic: 20-25ml
The sagittal plane next to the ultrasound probe was placed under the clavicle and inside the coracoid process, and the initial scan depth was set to 5 cm.
The pulsatile circular hypoechoic area under the pectoralis minor muscle is the axillary artery, and the honeycomb structure surrounding the axillary artery is the inner, outer and posterior bundles of the brachial plexus.
Axillary
Indications: Surgical anesthesia and analgesia for forearms and hands.
Position: Lie on your back with your upper arms abducted and your elbows flexed.
Block needle: 5cm&22G short bevel block needle
Ultrasound probe: high frequency linear array probe
Ultrasound technology: In-plane technology is often used to insert the needle from the outside, but also out-of-plane technology. The needle is inserted into the superficial and inner side of the axillary artery, and local anesthetic is injected to surround it. 4-5ml of local anesthetic alone blocks the musculocutaneous nerve.
Local anesthetic: 15-20ml
The ultrasound probe is placed perpendicular to the humerus at the intersection of the axillary pectoralis and biceps.
The median nerve, ulnar nerve, and radial nerve are scattered around the axillary artery in the axillary sheath, and the musculocutaneous nerve is in the coracobrachialis muscle.
