Indications
- Analgesia to axilla
- Lacerations or abscesses of axillary region
Contraindications
- Infection overlying injection site
- Allergy to local anesthetic
Equipment
- 30cc of local anesthetic of choice
- 18-22G needle
- Saline Flush
- Cleansing solution
- Ultrasound with high-frequency linear transducer
- Ultrasound transducer sterile cover
Preparation
Position
- Position the patient supine and head turned to contralateral side.
- Stand on opposite side with ultrasound screen in line.
Ultrasound
Landmarks
- Place transducer in sagittal plane at mid-clavicular line
- Identify the clavicle, pectoralis muscles and axillary artery and vein
- Translate the transducer caudad centering 3rd and 4th intercostal space
- Rotate the transducer 45° to identify the thoracoacromial artery between pectoralis major and pectoralis minor
Technique
- In-plane needle visualization
- Enter from medial aspect
- Deposit 10cc of local anesthetic separating fascial plane between pectoralis major and minor
- Advance needle to plane between pectoralis minor and serratus anterior
- Deposit remaining (20cc) local anesthetic
Example
