9 – Patient position, probe position and needle insertion

Place the patient supine with the head turned slightly contralateral

Use in-plane approach with the high-frequency linear probe in the axial plane at the level of the C4 nerve root typically corresponding to the level of the carotid bifurcation; alternatively the transverse process of C7 can be identified (the only transverse process with no anterior tubercle) and count the transverse processes upwards to the transverse process of C4

At the level of the C4 transverse process, the needle is inserted into the fascial plane between the deep and superficial cervical fascia deep to sternocleidomastoid muscle and from the postero-lateral margin of the sternocleidomastoid muscle with in-plane technique

Inject 20 mL of local anaesthetic to fill up the fascial space between the two cervical fascia