06/01/2026
Are You Using the Wrong Approach for Your Interscalene Block?
Not necessarily.
One reason some regionalists choose an out-of-plane or hybrid approach is to reduce needle travel through the middle scalene muscle, where the long thoracic nerve and dorsal scapular nerve are commonly found.
The concern?
Passing an in-plane needle through this area may increase the risk of contacting these nerves if they aren’t identified.
That’s why some clinicians prefer a steeper needle trajectory directed toward the brachial plexus.
That said, both techniques are acceptable when performed correctly.
Personally, I prefer an in-plane approach whenever possible. Why?
✅ Continuous needle visualization
✅ Better control of tip location
✅ Ability to identify and avoid nearby structures, including the long thoracic and dorsal scapular nerves
The “best” technique isn’t necessarily in-plane or out-of-plane.
It’s the one that allows you to:
• Consistently see your needle tip
• Safely avoid non-target structures
• Reliably deposit local anesthetic where it needs to go
The approach is a tool. Visualization is the goal.
📱 Did you know the PNBschool Mobile App includes free regional anesthesia modules covering interscalene, supraclavicular, femoral, adductor canal, PENG, IPACK, TAP, and more?
Free to download on the App Store and Google Play.
