USG probe cover is recommended and Supraclavicular fossa in transuerse position parallel to clavicle and brachial plexus and subclavian arlery are visualized.
First rib appears as hyperechoic line. Using in line approach, needle is advanced from lateral to medial till it reaches neural cluster of brachial plexus. Offer negative aspiration, local anaesthetic is injected. Injection should be stopped if the patient complaints of paresthesia or pain. Nerve stimulator can also be used as an adjunct to ultrasound. The nerve stimulator must be connected before local anaesthetic injection. With contraction of the arm, forearm, wrist occurs below ouma intraneural needle position may be likely and the needle should be withdrawn and redirected.