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 Background Several techniques for infraclavicular nerve blocks have been described. The coracoid approach was first described by Whiffler in the British Journal of Anaesthesia in 1981. This technique was most commonly used with nerve stimulation. The use of ultrasound offers more flexibility in approaches, giving the provider different choices for needle insertion depended on patients’ anatomy and best ultrasound image. [1, 2] All upper extremity blocks involve the brachial plexus. The brachial plexus arise from the anterior rami of C5-8 and T1 with some contribution from C4 and T2. The rami unite to form superior, middle, and inferior trunks. They occupy the space between the anterior and middle scalene muscles. Each trunk divides into anterior and posterior divisions, which rejoin to form 3 cords: the lateral, posterior, and medial. The medial brachial cutaneous and medial antebrachial cutaneous nerves come off the medial cord. The cords then pass into the axilla and divide into ner

 Infraclavicular plexus block: vertical approach COMPLEXITY: Indications • Anaesthesia and analgesia for upper arm, lower arm, and hand surgery • Analgesia for physiotherapeutic treatment • Treatment of pain syndrome • Sympathicolysis. Specifi c contraindications • Thorax deformity • Foreign bodies in the needle insertion area (e.g. pacemaker) • Clavicular malunion. Side effects and complications • Intravascular injection • Pneumothorax • Horner’s syndrome. See Figures 3.20, 3.21, and 3.22. Single injection technique Patient position: supine. Landmarks: acromion (ventral process) and clavicle. Technique: palpate the ventral process of the acromion. Make a mark 2 cm caudad and 2 cm medial to this point. Direct the needle sagittally, and advance approximately 3 cm (or to the same depth as the middle of the head of the humerus, depending on patient habitus). Correct placement of the needle will elicit fl exion of the fi ngers (median nerve) at a stimulating current of 0.3 mA/0.1 ms. Injec

 Sciatic nerve block: subgluteal to popliteal fossa COMPLEXITY: The sciatic nerve is a large structure and may be blocked at different levels to provide regional anaesthesia and analgesia for a wide range of indications. Consideration must be given to both the indication for the nerve block and the location where the sciatic nerve is best visualized with ultrasound to determine the best location to perform a block. Refer to Scanning tips for the lower extremities for a more detailed description of scanning the sciatic nerve. Indications • Hip surgery (proximal) • Surgery of the sciatic distribution • Leg surgery, when combined with a lumbar plexus block • Analgesia (proximal for above the knee; distal for below the knee) • Sympathicolysis (achillodynia, diabetic gangrene, circulatory or wound-healing disorders, complex regional pain syndrome) • Foot or ankle surgery. See Figures 4.42 to 4.52. Ultrasound-guided technique Patient position: the patient may be positioned semi-prone, with t

  Background The popliteal fossa has the semitendinosus and semimembranosus medially and the biceps femoris laterally. The sciatic nerve divides into the tibial and common peroneal nerve about 5–12 cm proximal to the popliteal crease. The sciatic nerve has a common epineural sheath that envelops the nerve trunks of the tibial and common peroneal nerve from their origin in the pelvis. The sciatic nerve is formed by the union of the first 3 sacral spinal nerves and the fourth and fifth lumbar nerves (see the image below). It is the largest nerve supplying the leg. It leaves the pelvis through the greater sciatic foramen and runs toward the posterior aspect of the thigh between the greater trochanter and the ischial tuberosity. It separates into its terminal branches about 6 cm proximal to the popliteal crease into the tibial nerve and the common peroneal nerve.  The tibial nerve supplies the heel and the sole of the foot. The common peroneal, also known as the common fibular nerve, inner