Initial injection for supraclavicular block

This video shows needle insertion and injection of local anesthetic for the "corner pocket" injection during supraclavicular block.

• The brachial plexus is visualized lateral to the subclavian artery.
• The first rib appears deep to the brachial plexus.
• The pleura is best visualized deep and lateral to the rib, moving with respiration.

The needle is inserted lateral and deep to the brachial plexus. Small aliquots of local anesthetic are injected to hydrodissect and allow the needle to be advanced into the "corner pocket", formed by the brachial plexus, the first rib, and subclavian artery. After negative aspiration, a bolus of local anesthetic is injected, visualized as a black (anechoic) space lifting the brachial plexus off of the first rib. For further details refer to UpToDate content on performing supraclavicular block.