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As mentioned above, this may help identify instances where the three visible nerve roots are actually C5 and a split C6 (as captured in the video below!) Dosing Ropivacaine 0.2% with a volume of 0.25-0.5 mL/kg to a maximum of 25mL can be injected in small aliquots with intermittent aspirations to make sure that the needle tip did not migrate intravascularly Ropivacaine 0.35% can also be used when a denser block is needed (a max dose of 2.5mg/kg) Additives like dexmedetomidine, clonidine, or dexamethasone can also be added if a longer duration block is desired Considerations Horner’s syndrome (local anesthetic spread to cervical sympathetic chain) Hoarseness (unclear etiology, though may be related to inadvertent blocking of phrenic and recurrent laryngeal nerves) Ipsilateral hemidiaphragm (inadvertent blockade of the phrenic nerve) Complications Subarachnoid, epidural, or vertebral artery injection Positioning, Probe Orientation & Sensory Loss Ultrasound Images Major shoulder surgery is characterized by severe acute postoperative pain necessitating a multidisciplinary approach to achieve effective multimodal analgesia
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