Interscalene block

CHAPTER 15 Interscalene block


Perform a systematic anatomical survey from medial to lateral and superficial to deep. The carotid artery and internal jugular vein are seen medially. Medial to the vessels, the thyroid and trachea are identified. The ultrasound-guided intrascalene block is performed at the lateral border of the clavicular head of the sternocleidomastoid at the level of the cricoid cartilage. Here the brachial plexus is a superficial structure and a high frequency ultrasound transducer (6 to 13 MHz) is used. A high frequency transducer allows good visualization of structures to a depth of 4–5 cm. The ultrasound transducer is placed in an axial oblique plain (Fig. 15.4) and the most superficial structure consistently encountered is the sternocleidomastoid muscle. This appears as a triangular structure with the apex pointing laterally. Immediately deep to the sternocleidomastoid muscle are the anterior and middle scalene muscles. These can be accentuated by asking the patient to sniff. The roots of the brachial plexus appear between these two muscles in the interscalene groove. At this level it is common to identify between one and five hypoechoic structures (roots or trunks) and, depending on the position of the ultrasound transducer, these may appear oval or round. The brachial plexus at this level lies at a depth of around 1 cm from the skin (Fig. 15.5).


Jul 28, 2016 | Posted by in ANESTHESIA | Comments Off on Interscalene block
Premium Wordpress Themes by UFO Themes