Interscalene nerve blocks
Interscalene nerve blocks
• Permission obtained and time out
• Sedate with versed and fentanyl
• Slight Trendelenburg
• Identify cricoid cartilage and mark it
• Turn head, Valsalva, and mark external jugular vein
• Mark the intersection of cricoid cartilage and external jugular vein
• Skin wheal, stimulator to 1.0 mA
• Direct needle to sternal notch
• Seek deltoid or biceps twitch @ 0.4 mA
• Ropivacaine 0.75% with epinephrine 1:200,000, 20 ml
• Kuhia takes a lot to time to get his landmarks correct. He identifies the lateral edge of the clavicular head of the sternocleidomastoid. He rolls off that edge down to the interscalene. He has the patient take a long, slow deep breath, and one can feel the scalenes flex at the height of the inhalation. He has the patient swallow to identify the cricoid.
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