will be blocked so this block should only be done on patients who have use of their accessory respiratory muscles. the block may not affect the c8 and t1 roots which supply part of the hand, so it is usually not done for hand surgeries. the supraclavicular and infraclavicular blocks can be performed for surgeries on the humerus, elbow, and hand. these blocks are indicated for the same surgeries but they provide different views of the nerves, so it depends on the individual patient's anatomy to determine which block should be performed. a pneumothorax is a risk with these blocks, so the pleura should be checked with ultrasound to make sure the lung was not punctured during the block. the axillary block is indicated for elbow, forearm, and hand surgery. it anesthetizes the median, ulnar, and radial nerves. this block is useful because it has less risk than the interscalene (spinal cord or vertebral artery puncture) or supraclavicular (pneumothorax) brachial plexus blocks. lower extremity lumbar plexus innervates the lower extremity. fascia iliaca block is indicated for pain relief for hip fractures in adults and femoral fractures in children. it works by affecting the femoral, obturator and the lateral cutaneous nerves. 3-in-1 nerve block is indicated for pain relief for hip fractures. the femoral nerve block is indicated for femur, anterior thigh, and knee surgery. it is performed slightly inferior to the inguinal ligament, and the nerve is under the fascia iliaca. the sciatic nerve block is done for surgeries at or below the knee. the nerve is located in the gluteus maximus muscle. the popliteal block is done for ankle, achilles tendon, and foot surgery. it is done above the knee on the posterior leg where the sciatic nerve starts splitting into the common peroneal and tibial nerves. the saphenous nerve block is often done in combination with the popliteal block for surgeries below the knee. the saphenous nerve is numbed at the medial part of the lower thigh under the sartorius muscle. the lumbar plexus block is an advanced technique indicated for hip, anterior thigh, and knee surgery. the lumbar plexus is composed of nerves originating from l1 to l4 spinal roots such as the iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral, and obturator nerves. since the plexus is located deep, there is an increased risk of local anesthetic toxicity, so less toxic anesthetics like chloroprocaine or mepivacaine mixed with ropivacaine are often recommended. a curvilinear ultrasound probe can be used but it is often difficult to see the plexus, so a nerve stimulator is used to locate it. paravertebral nerve the paravertebral block is versatile and can be used for various surgeries depending on the vertebral level it is done. a block at the neck in the cervical region is useful for thyroid gland and carotid artery surgery. at the chest and abdomen in the thoracic region, blocks are used for breast, thoracic, and abdominal surgery. one of the first instances on using continuous paravertebral blockade in the body was by the thoracic team led by sabanathan in bradford. a block at the hip in the lumbar region is indicated for hip, knee, and anterior thigh surgeries. the paravertebral block provides unilateral analgesia, but bilateral blocks can be performed for abdominal surgeries. since it is a unilateral block, it may be chosen over epidurals for patients who can't tolerate the hypotension that follows bilateral sympathectomy. the paravertebral space is located a couple centimeters lateral to the spinous process and is bounded posteriorly by the superior costotransverse ligament and anteriorly by the parietal pleura. complications include pneumothorax, vascular puncture, hypotension, and pleural puncture.