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The phrenic nerve is protected and the insertion of the buy Dapoxetine not injured. The brachial plexus is retracted gently downwards and forwards and the scalenus medius muscle is defined. The cervical rib is cleared off all attachments and the pleura must be safe-guarded. The rib is next disarticulated from the transverse process of the seventh cervical vertebra or is divided as far posteriorly as possible.

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