QUESTIONS & ANSWERS... SOLUTION 6
Regarding the supraclavicular block, choose the true answer:
A) It is the safest approach to the brachial plexus because there are no anatomical variations at this level
B) The in plane approach is not recommended
C) The AL must be deposited in a place called Corner Pocket to cover the radial nerve
D) The use of Doppler is recommended to identify the dorsal scapular artery
The neck is a very vascular area and care must be exercised to avoid needle placement or injection into the vascular structures. Occasionally you will find anatomical variations where the subclavian artery and vein are both together between the insertions of both of the scalene muscles. Of particular importance is to note the intimately located dorsal scapular artery which often crosses the supraclavicular brachial plexus at this level. The use of color Doppler before needle placement and injection is suggested.
The in-plane approach is probably a better and safer plan because of the proximity of the subclavian artery and the dome of the lung.
After injecting local into the sheath containing the brachial plexus it is highly advisable to reposition the needle in the angle formed by the subclavian artery at the 1st rib on the posterolateral side - “the Corner Pocket”. This is a common “hiding place” for the ulnar nerve.