Second injection for supraclavicular block

This video shows needle insertion and injection of local anesthetic for the second, superficial injection during supraclavicular block. The initial injection is in the "corner pocket" formed by the brachial plexus, the first rib and the subclavian artery.

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

After the "corner pocket" injection, the needle is withdrawn to beyond the lateral edge of the brachial plexus, and then angled superficially, advancing to place the tip superficial to the brachial plexus. After negative aspiration, local anesthetic is injected while visualizing spread around the trunks of the brachial plexus. For further details refer to UpToDate content on performing supraclavicular block.