12 – How to perform the infraclavicular brachial plexus block

Select a linear high-frequency probe. Adjust gain, focus and depth 3-4 cm

Turn the orientation mark on the probe cranially. Place the probe below the clavicle, medial to the coracoid process in the parasagittal plane

Locate the black, pulsatile axillary artery (AA) and align it to the centre of the monitor. Seeing AA as a clock face the lateral cord is located at nine o’clock, the posterior cord at six o’clock and the medial cord at two o’clock. Often the cords are not sonographically visible

Insert the needle below the clavicle and advance it in-plane aiming periarterially at seven o’clock. Empty the needle of air by injecting 1/2 mL local anaesthetic subcutaneously

Avoid piercing any vessels or nerves

The endpoint of injection is periarterially from two o’clock to ten o’clock. Reposition the needle tip as necessary to reach the endpoint