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A Safe Technique for the Supraclavicular Brachial Plexus Block

Gale E. Dryden, MD
JAMA. 1963;186(2):165. doi:10.1001/jama.1963.03710020085025.
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To the Editor:  —A safe and simple technique for the supraclavicular brachial plexus block is to locate the plexus by palpation. The head must be turned to stretch the nerves, and the shoulder must be depressed so the clavicle will not cover the brachial plexus as it crosses the first rib.The palpating finger is placed in the angle formed by the clavicle and external jugular vein. The first rib, subclavian artery, and the insertions of the anterior scalenus and clavicular head of the sternocleidomastoid muscles are identified. Firm pressure is exerted in the region of insertion of the anterior scalenus, and the finger is moved along the rib until the nerves are crossed; the nerves are identified by their denser structure, tenderness, and, sometimes, paresthesia to the arm. The plexus is then held impinged between the finger and the rib until the block needle is inserted directly into the


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