ABSTRACT
Anatomic landmarks are the point of the shoulder, the first rib, and the transverse processes of the cervical vertebrae. An area cranial and dorsal to the point of the shoulder is clipped and prepared with surgical scrub. This is often done during the preparation of the leg tor surgery. With the neck in a natural position, the cervical transverse processes will form a line which if continued, will usually traverse the proximal brachial plexus. An alternative method is to insert the needle proximal to the point of the shoulder. Using either approach, the needle should be inserted until the tip is just caudal to the first rib. A second technique utilizing an insulated locator needle can be used to help with accurate needle placement and reduce local anesthetic dose requirements. One lead from the nerve stimulator is attached to the skin and the other to the proximal portion of the needle.
