A modification of the interscalene brachial plexus block technique that allows multiple blocks to be done with minimal morbidity and discomfort.

To the Editor: We have previously published an article describing a new approach to the interscalene brachial plexus block (1). This technique uses the bony anatomy of the cervical spine as a landmark for directing the needle to the correct position, with the needle type being a 22gauge B-bevel shielded needle. However, studies are conflicting regarding bevel types and their association with peripheral nerve injury. While Selander et al (2) reported that short-bevel needles produce less injury, Rice and McMahon (3) reported more frequent, more severe and prolonged nerve injury following the use of a 27-degree (short-bevel) needle as opposed to a 12-degree (longbevel needle). It would appear that Bbevel needles, having a blunter tip due to a bevel of >45 degrees, may create more tissue trauma when inserted into the neck than do the sharp-tipped A bevel needles with a bevel of <20 degrees. A shielded needle is also thicker due to the insulating material around the needle. This letter describes the use of a 27-gauge regular beveled nonshielded needle to perform the block technique that we previously described A Modifi cation of the Interscalene Brachial Plexus Block Technique that Allows Multiple Blocks to be done with Minimal Morbidity and Discomfort