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The supraclavicular approach to local anesthetic blockade of the brachial plexus offers several advantages over other approaches. It has a high success rate and rapid onset of action (1). Compared with the axillary approach, it provides more complete anesthesia of the plexus, particularly the axillary and musculocutaneous nerves, and does not require abduction of the arm to perform. The interscalene approach is complicated by a higher incidence of injection into epidural or subarachnoid spaces or into the vertebral artery. It also is relatively difficult to master (1).The most significant problem that has prevented supraclavicular block from achieving widespread use has been pneumothorax, a complication that has a reported incidence of 0.6 to 5.0% (1). We describe a simple technique utilizing palpation of the first rib to improve the ease of supraclavicular brachial plexus block, which also should decrease the potential of lung injury. AnatomyThe brachial plexus and the subclavian artery cross over the first rib deep to the clavicle at its midpoint (Fig. 1). The plexus, at this level, is enclosed in a compartment bordered by the anterior scalene muscle and its fascial extension anteriorly and by the first rib posteriorly (Fig. 2). More superiorly, the posterior Received from the

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