LAUSR

The authors have chosen the supraclavicular fossa as their pre-injection site and administered 3 ml of local anaesthetic (LA) with the assumption that it would reach the CCS. However, one should keep in mind that even a small LA volume of 5 ml at the supraclavicular fossa may be associated with hemidiaphragmatic paralysis (HDP).[2] Therefore, we rather recommend a hydro-dissection technique using 0.9% saline at the CCS. In this method, as the needle passes the subclavius muscle and approaches the brachial plexus sheath (paraneural sheath),[3] small aliquots of 1-2 ml of 0.9% saline will be injected [Figure 1a] to appreciate if the injection is intramuscular or just outside the epimysium of the subclavius muscle/ paraneural sheath. Once confirmed, the block needle is gently advanced into the paraneural sheath between the lateral and posterior cords [Figure 1b] and a second injection of saline will now separate the tightly clustered cords. This helps to delineate the neural components.