Ultrasound-guided nerve block
Chest clavicle muscle, brachial plexus block, plexus nerve block
ANTERIOR, LOCAL ANAESTHETICS
The patient’s head is slightly tilted to the opposite side, a thin pillow is placed under the shoulder, and the high-frequency probe of the ultrasound (6–13 MHz, GE LOGIQ V3, Wuxi, Jiangsu, China) that is routinely maintained on a daily basis is placed parallel to the supraclavicular groove. The subclavian artery and the supraclavicular brachial plexus nerve are found and moved slowly to the head end until the brachial plexus nerve root in the intramuscular groove is observed. The puncture needle is inserted from the outside to the inside of the external jugular vein by in-plane technology. When the tip of the needle reached the periphery of the nerve root, 15 ml 0.33% ropivacaine (Guangdong Jiabo Pharmaceutical Co., Ltd., National Pharmaceutical Approval No. H20133178, Product Batch No. 7-B221103-1) 15ml was injected after no blood was drawn back is injected. In all patients the brachial plexus in the intramuscular groove was first blocked on the same side treated by the clavicular operation using one injection under the guidance of ultrasound. In group S, after the completion of the brachial plexus block in the intermuscular groove by one injection, an ultrasonic probe was directed to the head side of the sternocleidomastoid muscle to find the lateral intersection of the external jugular vein and the sternocleidomastoid muscle. The superficial cervical plexus ran between the superficial cervical fascia and the superficial layer of the deep cervical fascia. The puncture needle was inserted from the outside to the inside in the plane of the puncture needle. After the puncture needle reached the target position, 8 ml of 0.33% ropivacaine was given after no blood was drawn back from the other injection. In group F the ultrasonic probe was not moved after completing the intermuscular groove brachial plexus block, the needle was withdrawn to the distance between the superficial cervical fascia and the superficial layer of the deep cervical fascia, and 8 ml of 0.33% ropivacaine was given to expand the fascia of the same injection after confirming that the needle tip was at the target position and no blood was drawn back. The local anaesthetic was diffused along the fascia and injected approximately 4 cm in the ultrasound plane to the front of the sternocleidomastoid muscle (see Fig. 
Single injection for superficial cervical fascia block combined with brachial plexus block under ultrasound guidance. SCM: Chest clavicle muscle, SA: Anterior oblique muscle; SM: Middle oblique muscle; LA: Local anaesthetic; Blue arrow: puncture needle with shallow fascia block of the neck; White arrow: needle route of brachial plexus nerve block