1; The intermuscular sulcus is a triangle composed of scapular muscle and anterior scalene muscle, and the small triangle is a fixed point near the bottom. If the patient is obese or underdeveloped, the intermuscular groove 2 cm above the clavicle should be the puncture point.

Advantages: easy to master, can be stopped with a small amount, and will not cause pneumothorax. Disadvantages: Ulnar nerve block is surprisingly effective, which may damage the vertebral artery and risk entering the epidural space of subarachnoid space by mistake, so it is not suitable for simultaneous block on both sides.

2: The puncture point is at the middle point of clavicle 1~ 1.5 cm.

Advantages: simple, suitable for patients with unclear intermuscular groove, disadvantages: high incidence of pneumothorax.

3; Axillary; Touch the fluctuation of axillary artery at the armpit first, then touch the disappearance of axillary artery at the lower edge of pectoralis major upward along the artery trend, and touch the highest point of arterial pulsation slightly downward.

Advantages: shallow position, easy to block, no pneumothorax, no other danger. Disadvantages: it is not suitable for sealing upper limbs with difficulty in movement, with high incidence of toxic reaction and poor sealing effect.

Complications: pneumothorax, hemorrhagic hematoma, toxic reaction, phrenic nerve paralysis, hoarseness, etc.

We should learn from each other's strong points and choose the method suitable for patients to reduce the occurrence of complications.