Patient Position: Supine, with ipsilateral arm abducted, externally rotated, and flexed at the elbow.

Indications: Elbow, forearm, and hand surgery.

Needle Size: 22-gauge, 50-mm insulated needle.

Volume: 15 to 25 mL.

Ultrasonographic Landmarks: The biceps muscle lies anterosuperior to the neurovascular bundle, while the coracobrachialis muscle is superior to the neurovascular bundle, and the triceps muscle, inferior to neurovascular bundle. The humerus lies deep to the neurovascular bundle. The brachial artery and 1 to 2 brachial veins are evident in the neurovascular bundle. The radial, median, and ulnar nerves are found within the neurovascular bundle (Fig. 36-1A, C). Most commonly, the median nerve is anterior or cephaloanterior to the artery. The radial nerve is most commonly posterior or posteroinferior to the artery, while the ulnar nerve is most commonly found inferior or anteroinferior to the artery. Proximal in the axilla, the musculocutaneous nerve may be found cephaloposterior to the artery. In more distal sites in the axilla, the musculocutaneous nerve is usually found in the fascia between the biceps and coracobrachialis muscles 1 to 2 cm cephaloposterior to the artery. Cutaneous nerves of the arm or forearm may also be visualized.

Transducer Position: Transverse across the axilla (sagittal oblique), placed at the intersection of the pectoralis and biceps muscles.