Patient Position: Supine, with ipsilateral arm abducted 120° with the elbow flexed 90°. This position rotates the plexus away from the pleura and closer to the surface of the skin.

Indications: Elbow, forearm, or hand surgery.

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

Surface Landmarks: Clavicle and deltopectoral groove. Skin over the pectoralis major muscle.

Ultrasonographic Landmarks: Note the pectoralis major and minor muscles, and the clavipectoral fascia immediately deep to the pectoralis minor muscle (Fig. 35-1). The axillary artery and axillary vein lie just beneath the clavipectoral fascia. Adjacent to the artery are found the cords of brachial plexus: the lateral cord (cephaloanterior), posterior cord (cephalad), and medial cord (cephaloposterior). The pleura and second or third rib are seen deep to the axillary artery, vein, and plexus (Fig. 35-1).

Transducer Position: In sagittal plane with the probe positioned 1 cm below the clavicle and 1 to 2 cm medial to the deltopectoral groove.

Volume: 15 to 20 mL.