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Interscalene Brachial Plexus

Nerve Block Indications

Shoulder Surgery, Brachial Neuritis, Shoulder Pain, Frozen shoulder
Ultrasound Guided CME Course for Regional Anesthesia and Pain featuring interscalene brachial plexus block

Interscalene Brachial Plexus Video

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Interscalene Region

Provides Anesthesia of the:

Shoulder, Lateral clavicle, Acromioclavicular joint, Proximal humerus, Elbow,
interscalene nerve block coverage

Brachial Plexus Anatomy

The Interscalene Brachial Plexus is ideal for analgesia of the shoulder and upper extremity. Due to its location, it will not reliably anesthetize the ulna nerve as the C8 to T1 nerve roots have yet to join the plexus at this access point.
Brachial Plexus Anatomy

Indications for Block

  • Shoulder Surgery
  • Brachial Neuritis
  • Shoulder Pain 
  • Frozen shoulder

For Board Prep Check out:


Locating the Brachial Plexus (described in video)

  • Start in the anterior midline at the level of the thyroid gland and move laterally, identifying the carotid, internal jugular and then the anterior scalene and middle scalene, triangulating against the sternocleidomastoid muscle in the scan

  • Alternatively you can start from the supraclavicular space and run the probe upwards

  • A good place to end your search is where the nerves are lined up vertically (perpendicular to the probe) and the most lateral trunk (the superior trunk) is at it's most superficial position. “low” interscalene or “high” supraclavicular position from an external perspective


Often related to proximity of interscalene nerves to the:

vertebral artery, the dome of the pleura, the dura covering the cervical spinal cord, the cervical spinal cord, carotid artery, internal jugular vein, phrenic nerve leading to hemidiaphragmantic paralysis

Interscalene Brachial Plexus Dosing

Regional Anesthesia: 7-15ml of local anesthetic such as bucpivicaine 0.25% Interventional Pain: 1-2 ml of local anesthetic with 2-4mg of dexamethasone per nerve
Dosing of Interscalene Brachial Plexus Block


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