Intermuscular sulcus path nerve block

The patient lies on his back with his head to the opposite side and his arms to the side with the shoulders down. Let the client raise his head slightly to expose the clavicular end of the sternocleidomastoid muscle. Run his finger outward at the posterior edge and feel a small muscle called the scalenus anterior. The indentation between the anterior and middle scalenes is the intermuscular sulcus. The intermuscular sulcus is triangular with small upper and large lower. The subclavian artery can be reached by running your finger under the sulcus. A horizontal line from the cricoid cartilage to the intersection of the intermuscular sulcus is the puncture site, which corresponds to the level of the transverse process of the 6th cervical vertebra. Enter the needle vertically with the 7 gauge needle and the skin. There can be a breakthrough feeling when puncturing the prevertebral fascia, and then enter a little inward toward the foot. When the needle touches the brachial plexus, the patient often complains of different sensations. At this time, there is no blood or cerebrospinal fluid withdrawn, and local anesthetics can be injected. 25ml of 1.3% lidocaine containing 1:200,000 epinephrine (5 μg /ml) is commonly used.