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flying the probe near the clavicle allows the subclavian artery to be identified the plexus lies lateral to it tilting the probe into the neck and moving it proximally to follow the plexus leads into the inter scalene groove here the roots appear as round hypoechoic structures between the scalene muscles indenting the skin allows confirmation of the needle entry point puncture site analgesia is administered after inserting the needle just beneath the skin the probe angle is adjusted to allow visualization of the needle tip small bouncing movements of the needle tip cause tissue displacement and aid the needle tip visualization the needle is gently advanced anterior to the roots the aim is to place the needle near c5 and c6 in this clip the nerve stimulator is used for demonstration purposes only even once within the groove small needle tip adjustments are required to elicit the biceps muscle contraction a small injection of local anesthetic confirms correct spread within the into scale
