9 – How to perform an ultrasound guided interscalene brachial plexus block

– Select a high-frequency linear probe
– Adjust gain, focus, and depth 2-3 cm
– Turn the orientation mark on the probe postero-lateral on the right side and antero-lateral on
the left side of the patient
– Place the probe behind the clavicle on top of the first rib oriented practically in the
parasagittal plane
– Locate the black, pulsatile subclavian artery (SA) on top of the first rib between the anterior
and the middle scalene muscles
– Locate the branches of the brachial plexus (BP) posterior to the SA
– Track the BP branches proximally until the profiles of the C5 and C6 spinal nerve roots line
up like a string of black pearls in the interscalene groove. C5 appears as one profile, C6 as
two
– Capture the best possible cross sectional image by tilting the probe and fine-tuning gain,
focus, and depth