FIGURE 1. Expected sensory distribution of the supraclavicular brachial plexus nerve block.

FIGURE 2. Anatomy of the supraclavicular brachial plexus with proper transducer placement slightly oblique above the clavicle (Cl). Yellow arrow: brachial plexus (BP). SA, subclavian artery.

FIGURE 3. Supraclavicular brachial plexus (BP; yellow arrows) seen slightly superficial and posterolateral to the subclavian artery (SA). The brachial plexus is enveloped by a connective tissue sheath. Note the intimate location of the pleura and lung to the brachial plexus and subclavian artery. MSM, middle scalene muscle.

FIGURE 4. Ultrasound images of the brachial plexus cephalad to the clavicle. (A) Sagittal view: The upper (UT), Middle (MT) and lower (LT) trunks of the brachial plexus are seen posterior to the subclavian artery (SA) and superficial to the first rib. (B) Oblique view: The upper trunk (UT) is positioned between the anterior (ASM) and middle (MSM) scalene muscles. The lower trunk (LT) and the subclavian artery are superficial to the pleura.

FIGURE 5. Supraclavicular brachial plexus nerve block: transducer position just proximal the clavicle and needle insertion. The brachial plexus is very shallow at this location, typically 1–3 cm; therefore, inclination of the needle should be equally shallow. The image also shows the caudal tilt that is useful in obtaining best image of the plexus

FIGURE 6. Supraclavicular brachial plexus nerve block: needle path and two separate injections required for nerve block of the brachial plexus. Two needle positions (1 and 2) are used to inject local anesthetic within the connective tissue sheath (arrows) containing the brachial plexus (BP)

FIGURE 7. The desired spread of local anesthetic (blue-shaded areas) in two different needle positions to accomplish brachial plexus (BP) nerve block. Local anesthetic should spread within the connective tissue sheath resulting in separation of the brachial plexus trunks posterior to the subclavian artery (SCA)

FIGURE 8. Ultrasound image simulating needle path and expected local anesthetic spread after a single injection within the connective tissue sheath surrounding the brachial plexus. Additional monitoring (eg, nerve stimulation and injection pressure) is recommended to decrease the risk of intrafascicular injection

FIGURE 9. Ultrasound-guided supraclavicular brachial plexus nerve block simulating a single injection between the subclavian artery (SA) and the first rib
 

SOURCE FROM https://www.nysora.com/