The apex of the interscalene triangle is the ideal place to administer brachial plexus block for clavicle and shoulder surgeries. Always elicit paraesthesia in fingers for any brachial plexus block, any route, your block will be near 100%. Add anxiolytic (Midazolam 2 mg) and an adjuvant opioid/ Dexmedetomidine etc Superior cervical plexus block can also be added, for best results. I usually give both for clavicle fractures. The interscalene triangle can be divided into 3 parts cephalocaudally apical 1/3rd, middle 1/3rd and lower 1/3 rd.
Apical blocks: Ideal for clavicle, humerus and shoulder surgeries. Middle 1/3rd blocks: Ideal for elbow, forearm surgeries. Lower 1/3rd blocks: Ideal for wrist and hand surgeries. If ulnar sparing is suspected, block ulnar at an elbow. Share your opinion.
