ISO (Infraclavicular–SubOmohyoid) block: a single-puncture technique for diaphragm- and opioid-sparing shoulder anaesthesia

Editor—The shoulder joint and its muscles are entirely supplied by the brachial plexus and can be anaesthetized simply using the interscalene block. However, this proximal placement of local anaesthetic results in spread to many crucial neural structures (especially the phrenic nerve). To bypass this complication, distal block of the shoulder innervation is recommended.¹ Distally, the shoulder nerves are discrete, so multiple injections are usually required to achieve adequate analgesia. Blocking the axillary nerve and suprascapular nerve can provide adequate analgesia for minor shoulder surgery, but for major surgery both infraclavicular and suprascapular nerve blocks are required.¹ To minimize block time and patient discomfort, we perform both infraclavicular and suprascapular nerve blocks through a single-puncture technique (the ISO block).

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