case_images: PMC6341887_01
case_images: (a) Technique of ISB, 18G Tuohy needle near brachial plexus under high-frequency ultrasound probe and in-plane approach. (b) Catheter is clearly visualised near the lower end of brachial plexus; (c) Contrast spread within the brachial plexus sheath and cervical epidural space (arrows). SA: scalene anterior muscle; SM: scalene medius muscle; BP: brachial plexus; SCM: sternocleidomastoid muscle; SA: scalene anterior muscle; SM: scalene medius muscle
case_images: IJA-63-55-g001.jpg
case_images: PMC6341887_01_IJA-63-55-g001.jpg
case_images: F1
case_images: Tuohy needle (5 cm beyond the tip and fixed at 7 cm mark at skin) to be used for supplemental intraoperative anaesthesia and postoperative analgesia [Figure 1a and b]. Block effect was excellent, intraoperative sedation was provided by infusion of dexmedetomidine 4-12 mug/h and surgery and anaesthesia were uneventful. Initial injection showed spread of contrast within the brachial plexus sheath (thus catheter migration was ruled out); however, when 10 mL of saline was injected further, spread of contrast to the cervical epidural spacewas noticed [Figure 1c].