PMC2743892_01
A, The patient is placed in the right lateral decubitus position. The junction of the levator scapulae and trapezius muscles is identified by the "V." B, A 1 7-gauge Tuohy-tip needle is directed under in-plane ultrasound guidance through the middle scalene muscle toward the brachial plexus.
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F1
Standard American Society of Anesthesiologists (ASA) monitors and oxygen via facemask were applied, the patient was positioned right lateral decubitus with the head of the bed slightly raised, and the skin was prepared with antiseptic solution prior to application of a sterile drape (Fig. 1A). At the junction of the levator scapulae and trapezius muscles (Fig. 1A), 1% lidocaine was injected to anesthetize skin, and the track into the middle scalene muscle under ultrasound guidance. Under continuous in-plane ultrasound guidance (probe held in the operator's left hand), the needle (in the operator's right hand) was directed anteriorly toward the brachial plexus, passing lateral to the posterior scalene and through the middle scalene muscles (Fig. 1B).
A, The perineural catheter has been tunneled posteriorly beneath the hairline. The initial catheter placement site has been covered by liquid adhesive and a clear occlusive dressing. B, The anchoring device has been secured on the contralateral shoulder to avoid the anticipated surgical field. C, Following a 40 mL bolus injection of 0.5% ropivacaine, unilateral upper extremity anesthesia has been achieved in a distribution typical of the interscalene block (shaded area).
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F2
Using the 17-gauge Tuohy needle, the catheter was tunneled subcutaneously below the hairline (Fig. 2A) toward the contralateral side to avoid the surgical field, and affixed to the contralateral shoulder using liquid adhesive and clear occlusive dressings (Fig. 2B). An initial 40 mL bolus of ropivacaine (0.5%) with epinephrine (2.5 microg/mL), injected under ultrasound visualization (Fig. 2C), produced topical anesthesia to cold and light touch in the distribution typical of an anterolateral interscalene single-injection block within 15 minutes (Fig. 2C).