Procedure of IBPB
nerve block
STERILE
The patient was in the supine position with the head slightly turned away from the operative side. The skin was prepared using an antiseptic solution, and the transducer was wrapped in a sterile cover. A 6-13-MHz high-frequency linear probe of the ultrasound (Philips CX50, Philips Ultrasound, Inc., Bothell, WA, USA) was used to identify the C5-C6-C7 nerve roots of the brachial plexus. Then a 21G*100mm insulated needle (UniPlex NanoLine, Pajunk, Geisingen, Germany) was advanced via the lateral-to-medial approach to target the nerve root, and then ropivacaine alone or ropivacaine with dexmedetomidine was injected around the nerve root. All nerve blocks were performed by experienced anesthesiologists who had performed at least 30 blocks with the research technique before beginning the study. At the end of the nerve block, neostigmine 0.04 mg/kg and atropine 0.02 mg/kg were given to reverse the residual neuromuscular block. The patients were extubated awake and transferred to the post-anesthesia care unit (PACU) (Fig. Ultrasound image of interscalene brachial plexus block. ICA, internal carotid artery; ASM, anterior scalene muscle; MSM, middle scalene muscle; BP, brachial plexus; N, needle