1. Vanza’s 10/20/30 rule”
  • Interscalene 10mls or less (to reduce phrenic nerve blockade)
  • Supraclavicular 20mls
  • nfraclavicular 30mls
2. Interscalene – scan up from supraclavicular level to identify each transverse process and corresponding nerve root. Try to deposit LA around C5/C6
  • Add supraclavicular NERVE block (not plexus block) to your interscalene block for shoulder surgery to account for anterior port. Supraclavicular nerve pathway located over anterior border middle scalene muscle

3. Supraclavicular – use a 100mm needle and have needle insertion point 3-4cm from probe to increase horizontal needle visualization

4. Infraclavicular – aim for a U-shaped area of local below the subclavian/axillary artery

Further Reading: