Interscalene Brachial Plexus Block for Shoulder Surgery
Anjan Trikha1992, Anesthesia & Analgesia
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Abstract
A five-year-old child with severe arthrogryposis multiplex congenita and malnutrition underwent surgery for chronic osteomyelitis of the head of the left humerus. The child had typical features of arthrogryposis multiplex congenita, including a difficult airway. Propofol was used for induction and maintenance. Spontaneous respiration was maintained with a nasal airway. Analgesia was provided with an interscalene brachial plexus block placed using a nerve stimulator. No opioid was given. The child had an uneventful recovery with good postoperative analgesia. The anaesthetic implications of arthrogryposis multiplex congenita are discussed.
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Interscalene brachial plexus block anesthesia for upper extremity surgery
The Journal of Hand Surgery, 1986
Administration of local anesthetic agents into the interscalene space usually provides adequate anesthesia for surgical procedures on the glenohumeral joint. The anatomic basis and anesthetic technique of interscalene brachial plexus block are described. A retrospective evaluation of 65 modified Bristow procedures is presented, in which 46 procedures performed under this form of regional anesthesia were compared with the 19 that had primary administration of general anesthesia. Those patients who had regional anesthesia had, on the average, a shorter hospital stay, significantly less blood loss, and presumably the advantages of local anesthesia. It is suggested that interscalene brachial plexus block be considered as a viable alternative to general anesthesia for the modified Bristow procedure.
Neurologic Sequelae After Interscalene Brachial Plexus Block for Shoulder/Upper Arm Surgery: The Association of Patient, Anesthetic, and Surgical Factors to the Incidence and Clinical Course
Anesthesia & Analgesia, 2005
We determined the incidence, distribution, and resolution of neurologic sequelae and the association with anesthetic, surgical, and patient factors after single-injection interscalene block (ISB) using levobupivacaine 0.625% with epinephrine 1:200,000 in subjects undergoing shoulder or upper arm surgery, or both, in 693 consecutive adult patients. After a standardized ISB, assessments were made at 24 and 48 h and at 2 and 4 wk for anesthesia, hypesthesia, paresthesias, pain/dysesthesias, and motor weakness. Symptomatic patients were monitored until resolution. Subjects reporting pain or discomfort Ͼ3 of 10 and those with motor or extending sensory symptoms received diagnostic assessment. Six-hundred-sixty subjects completed 4 wk of follow-up. Fifty-eight neurologic sequelae were reported by 56 subjects. Symptoms were sensory except for two cases of motor weakness (lesions identified distant from the ISB site). Thirty-one sequelae with likely ISB association were reported by 29 subjects, including 14 at the ISB site, 9 at the distal phalanx of thumb/
Efficacy of low dose Interscalene Brachial Plexus Block on post anesthesia recovery parameters after Shoulder Surgery
Pakistan Journal of Medical Sciences Online
Objective: Excellent postoperative pain control plays central role in the outcome of open shoulder surgery which provides early rehabilitation and accelerates functional recuperation. Methodology: Fifty patients who were candidate for elective shoulder surgery were enrolled in this study. Patients were randomized to two 25-patient groups. One group received morphin sulfate and in the other group small volume Interscalene Brachial Plexus Block (ISBPB) was performed. Pain severity, patient satisfaction scores and post anesthesia recovery parameters were assessed. Results: Patients satisfaction score was significantly improved in ISBPB (P<0.001). Agitation in ISBPB group was significantly reduced compared to the other group (P: 0.009). Pain severity score was significantly reduced with ISBPB (P=0.001). ISBPB did not have any side effects on post anesthesia recovery parameters. Conclusion: Small volume ISBPB may be considered as a suitable technique for reducing intermediate postoperative pain without any effect on post anesthesia care unit parameters and stay in patients undergoing open shoulder surgery.
Supraclavicular brachial plexus block as a sole anaesthetic technique in children: an analysis of 200 cases
Anaesthesia, 2000
Classical supraclavicular brachial plexus block was used as the sole anaesthetic technique in 200 children aged between 5 and 12 years undergoing closed reduction of arm fractures. The local anaesthetic used was lidocaine 1.5% with epinephrine. The block was graded as satisfactory if surgical manipulation could be performed without discomfort and unsatisfactory if general anaesthesia had to be given. In 182 children, the procedure was carried out under the block alone, whereas the remaining 18 patients required general anaesthesia. The mean (SD) time required for performing the block was 9.1 (3.7) min and the mean (SD) time to sensory blockade was 8.3 (2.3) min. The mean duration of analgesia was < 3.5 h. There were few complications, with no incidence of pneumothorax in any patient. The acceptability of the block by the children and the parents was 72 and 85%, respectively. The classical supraclavicular brachial plexus block was found to be acceptable, effective and with a good success rate.
DOES THE ADDITION OF DEXAMETHASON TO LOCAL ANESTHETIC PROLONG THE ANALGESIA OF INTERSCALEN PLEXUS BRACHIALIS BLOCK IN PATIENTS WITH SHOULDER SURGERY
Introduction: Peripherial nerve blocks is a suitable alternative to general anesthesia especially for one-day case surgery. Interscalene approach of ple-xus brachialis block as much as supraclavicular and in-fraclavicular provide reliable, safe, effective, low cost and most complete anesthesia with satisfactory postop-erative analgesia for upper limb surgery. Postoperative analgesia of plexus brachialis blocks can be prolonged by using different drugs as adjuvants with local anesthetics. Dexamethasone has been shown to prolong the duration of postoperative analgesia when given as an adjunct for peripheral nerve blocks. The investigation was randomized, prospective, double blinded and controlled study. Objective: The study was designed to compare the effects of dexamethasone administered as an adjunct to bupivacaine in interscalene brachial plexus block on the onset, duration and postoperative analge-sia in patients under the shoulder surgery. Methods: A prospective, double-blind study was undertaken in patients scheduled for shoulder surgeries under the interscalene brachial plexus block. We enrolled 60 patients, ASA I-II both sexes, aged 19-65 years, weighing 54-89 kg, divided to two groups G1 and G2. The brachial plexus block was performed by interscalene approach and mixture of 2% lidocaine (12 ml) and 0.5% bu-pivacaine (22 ml) either alone or combined with dexa-methasone (4 mg). The block was performed by using double technique neurostimulator/ultrasound technique. Results: In our investigation we found a significant increase in onset and duration of motor and sensory block in Group G2 (with dexamethasone) as compared to Group G1 patients (p < 0.01). Conclusion: Addition of dexamethasone to local anesthetic drugs in interscalene plexus brachialis block, significantly prolongs the duration of analgesia and motor block in patients undergoing shoulder arthro-scopy. Moreover, it is a remarkably safe and cost effective method of providing postoperative analgesia.
Brachial plexus blocks: a review of approaches and techniques
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2007
and "humeral canal" were searched for full text articles pertaining to the evaluation of recognized approaches and techniques for brachial plexus anesthesia. The search was limited to RCTs involving human subjects and published in the English language. Seventy-six RCTs were identified.
Interscalene Brachial Plexus Anesthesia and Analgesia for Open Shoulder Surgery: A Randomized, Double-Blinded Comparison Between Levobupivacaine and Ropivacaine
Anesthesia & Analgesia, 2003
We compared the onset time and quality of interscalene brachial plexus block produced with levobupivacaine and ropivacaine in 50 patients undergoing open shoulder surgery randomly allocated to receive 30 mL of 0.5% levobupivacaine (n ϭ 25) or 0.5% ropivacaine (n ϭ 25) injected through a 20-gauge catheter placed into the interscalene sheath using a 18-gauge insulated and stimulating Tuohy introducer. The block was also prolonged after surgery using a patient-controlled interscalene analgesia with 0.125% levobupivacaine or 0.2% ropivacaine, respectively (basal infusion rate, 6 mL/h; bolus, 2 mL; lockout period, 15 min; maximum boluses per hour, three). Three patients (two with levobupivacaine [8%] and one with ropivacaine [4%]) failed to achieve surgical block within 45 min after the injection and were excluded. The onset time of surgical block was 20 min (10 -40 min) with levobupivacaine and 20 min (5-45 min) with ropivacaine (P ϭ 0.53). Rescue intraoperative analgesia (0.1 mg of fentanyl IV) was required in eight patients in each group (34%) (P ϭ 0.99). Forty-two patients completed the 24-h postoperative
Permanent upper trunk plexopathy after interscalene brachial plexus block
Journal of Clinical Monitoring and Computing, 2015
Interscalene brachial plexus block (IBPB) has been widely used in shoulder surgical procedures. The incidence of postoperative neural injury has been estimated to be as high as 3 %. We report a long-term neurologic deficit after a nerve stimulator assisted brachial plexus block. A 55 year-old male, with right shoulder impingement syndrome was scheduled for elective surgery. The patient was given an oral dose of 10 mg of diazepam prior to the nerve stimulator assisted brachial plexus block. The patient immediately complained, as soon as the needle was placed in the interscalene area, of a sharp pain in his right arm and he was sedated further. Twenty-four hours later, the patient complained of severe shoulder and arm pain that required an increased dose of analgesics. Severe peri-scapular atrophy developed over the following days. Electromyography studies revealed an upper trunk plexus injury with severe denervation of the supraspinatus, infraspinatus and deltoid muscles together with a moderate denervation of the biceps brachii muscle. Chest X-rays showed a diaphragmatic palsy which was not present post operatively. Pulmonary function tests were also affected. Phrenic nerve paralysis was still present 18 months after the block as was dysfunction of the brachial plexus resulting in an inability to perform flexion, abduction and external rotation of the right shoulder. Severe brachial plexopathy was probably due to a local anesthetic having been administrated through the perineurium and into the nerve fascicles. Severe brachial plexopathy is an uncommon but catastrophic complication of IBPB. We propose a clinical algorithm using ultrasound guidance during nerve blocks as a safer technique of regional anesthesia. Keywords Brachial plexus block Á Interscalene block Á Neurostimulation Á Nerve injury Á Intraneural injection Á Ultrasound This article was presented at Annual Assembly of the American Academy of Physical and Rehabilitation Medicine, Washington (USA) 3-6 October 2013.
Anesthesia for Arthroscopic Shoulder Surgery
Modern Arthroscopy, 2011
Comparison between continuous posterior and lateral interscalene brachial plexus blockades for major shoulder surgery
Egyptian Journal of Anaesthesia, 2011
Background: Postoperative pain relief after major shoulder surgery is extremely challenging. Continuous interscalene blockade is considered a well suited pain management technique for this type of surgery, but with technical difficulties. The aim of this study was to compare the efficacy and safety of continuous posterior and conventional lateral interscalene brachial plexus blockades. Methods: This prospective randomized study included 40 patients who were radomally allocated into two equal groups (n = 20 patients), in the first group, continuous lateral interscalene blockade was done (Lateral Group), while continuous posterior interscalene was performed in the second group (Posterior Group). The measurement data were patient characteristics and surgical data, easiness of catheter insertion, onset of blockade, catheter insertion and total blockade times. Side effects encountered during blockade and postoperative efficacy of analgesia as well as patients satisfaction were also measured. Results: There was no significant difference as regards the onset of anesthesia in both groups. Block procedure time and catheter placement times were faster in the posterior group
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Anesthesiology and pain medicine, 2015
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Randomized, controlled trial comparing respiratory and analgesic effects of interscalene, anterior suprascapular, and posterior suprascapular nerve blocks for arthroscopic shoulder surgery
Korean Journal of Anesthesiology, 2020
BackgroundInterscalene brachial plexus block (ISB) provides excellent analgesia for arthroscopic shoulder surgeries but is associated with adverse effects including hemidiaphragmatic paresis. We aimed to compare the respiratory effects, forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) between suprascapular nerve block (SSB) and ISB.MethodsSixty patients were recruited and randomized into ISB, anterior SSB, and posterior SSB groups. FVC, FEV1, and diaphragmatic excursion were evaluated at baseline and 30 minutes after intervention. Blocks were performed under ultrasound guidance with 15 ml of 0.5% ropivacaine. Pain scores were assessed at 6, 12, and 24 hours postoperatively.ResultsThe ISB group showed a reduced FVC of 31.2% ± 17.5% (mean ± SD), while the anterior and posterior SSB groups had less reduction of 3.6% ± 18.6% and 6.8% ± 6.5%, respectively (P < 0.001). The ISB group showed more reduction in diaphragmatic excursion than the anterior and poste...
Interscalene brachial plexus block for shoulder arthroscopic surgery: Prospective randomised controlled study of effects of 0.5% ropivacaine and 0.5% ropivacaine with dexamethasone
Indian Journal of Anaesthesia, 2015
Background and Aims: Various adjuvants have been used to prolong the duration of local anaesthetic action after peripheral and regional nerve blocks. We evaluated the effect of dexamethasone on the duration of pain relief in shoulder arthroscopic surgeries performed under interscalene brachial plexus using ropivacaine as local anaesthetic. Methods: After Ethical Committee approval and informed consent from patients we performed a prospective, randomised, comparative study on patients scheduled for arthroscopic shoulder surgery under interscalene block (ISB). Patients in ropivacaine group (Group R) received 30 ml of 0.5% ropivacaine plus 2 ml normal saline (n = 50) and dexamethasone-ropivacaine (Group RD) received 0.5% ropivacaine 30 ml plus 8 mg dexamethasone (4 mg/ml) (n = 50). Duration of analgesia, onset of sensory and motor block, success and failure of block, and complications were recorded and compared. Computer software SPSS version-16 (SPSS Inc., Chicago, Illinois, USA) was used for statistical analysis. Chi-square test and Student's t-test were used and P < 0.05 was considered as significant. Results: The mean duration of analgesia in Group RD was 1103.72 ± 296.027 min and in Group R it was 551.54 ± 166.92 min (P = 0.0001). Onset of sensory block in Group RD was 12.24 ± 1.88 min and in Group R was 13.48 ± 1.81 min (P = 0.5170). Onset of motor block in Group RD was 16.24 ± 2.04 min and in Group R was 17.76 ± 2.21 min (P = 0.2244). Onset of surgical anaesthesia in Group RD was19.46 ± 1.86 min and in Group R was 20.84 ± 1.71 min (P = 0.0859). Conclusion: Dexamethasone significantly prolonged duration of analgesia of ropivacaine during ISB used for arthroscopic surgeries of shoulder. Dexamethasone when mixed with ropivacaine had no effect on the onset of sensory and motor effects of ISB with ropivacaine.
Comparison of Diaphragmatic Paralysis, Respiratory Function and Postoperative Pain After Interscalene Brachial Plexus Block With a Reduction Dose of Levobupivacaine 0.25% 10 ml Versus 20 ml Undergoing Arthroscopic Shoulder Surgery: Study Protocol for the Randomized, Controlled and Double-blinded ...
Background: Arthroscopic shoulder surgery involves dynamic and severe postoperative pain. Interscalene brachial plexus block provides adequate analgesia, but the spread of local anaesthetics administered causes a phrenic nerve block that entrains a nonnegligible incidence of hemidiaphragmatic paralysis acute.The main objective of this trial is to compare the hemidiaphragmatic paralysis after interscalene brachial plexus block in arthroscopic shoulder surgery, between a standard volume (20 ml) and a low volume (10 ml) of 0.25% levobupivacaine.Methods: This is a comparative, prospective, single-center, double-blind, two-arm randomized controlled trial. Forty-eight patients will be included. The primary end-point is to determine the hemidiaphragmatic paralysis incidence diagnosed by the diaphragmatic thickness ratio in ultrasound. The secondary endpoints are as follows: (1) hemidiaphragmatic paralysis incidence diagnosed by forced vital capacity and (2) forced expiratory volume at 1 se...
Delayed Quadriparesis After an Interscalene Brachial Plexus Block and General Anesthesia: A Differential Diagnosis
Anesthesia and Analgesia, 2009
Interscalene brachial plexus block has been widely used for upper limb surgery. Different neurological complications related to this technique have been published. We report a case of quadriparesis of delayed onset, without loss of consciousness or cardiopulmonary compromise after an interscalene block and general anesthesia in a seated position.
The Effects and Side Effects of Interscalene Brachial Plexus Block by Posterior Approach
Regional Anesthesia and Pain Medicine, 1998
[Comparison of interscalene brachial plexus block and intra-articular local anesthetic administration on postoperative pain management in arthroscopic shoulder surgery]
Revista brasileira de anestesiologia, 2015
In this study, the aim was to compare postoperative analgesia effects of the administration of ultrasound-guided interscalene brachial plexus block and intra-articular bupivacaine carried out with bupivacaine. In the first group of patients 20mL 0.25% bupivacaine and ultrasound-guided interscalene brachial plexus block (ISPB) were applied, while 20mL 0.25% bupivacaine was given via intra-articular (IA) administration to the second group patients after surgery. Patients in the third group were considered the control group and no block was performed. Patient-controlled analgesia (PCA) with morphine was used in all three groups for postoperative analgesia. In the ISPB group, morphine consumption in the periods between 0-4, 6-12 and 12-24 postoperative hours and total consumption within 24h was lower than in the other two groups. Morphine consumption in the IA group was lower than in the control group in the period from 0 to 6h and the same was true for total morphine consumption in 24h...
Comparison of post operative analgesia supraclavicular brachial plexus block in children 5 to 10 years of age
International Journal of Medical Research and Review, 2016
Background: Regional anesthesia is a recommended technique for upper limb surgeries with better postoperative profile. However paediatric regional anaesthesia for upper limb surgeries was till now difficult due to various problems like moving child, inability to elicit parasthesia and likely injury to brachial plexeus. With the advent of nerve stimulators and ultrasound guided blocks, we can now overcome the above problems. We evaluated the effect of ultrasound guided bupivacaine for quality and duration of post op analgesia. Methodology: Sixty paediatric patients posted for elective and emergency upper limb surgeries were enrolled for a prospective, randomized, study. Patients were divided into two groups, the control group A and the study group B. In group A (n =30) patients were given general anaesthesia for the surgery and at the end of it, conventional analgesics were given and In group B (n = 30), after GA, 10 ml of 0.325% bupivacaine + normal saline were given ultrasound guided supraclavicular brachial plexus block. Quality and duration of post op analgesia and time to first rescue analgesia were recorded. Results. The onset times for pain was significantly shorter in A than B group (p < 0.05). The duration of analgesia (DOA) was significantly longer in B group than A group (p < 0.0001). Heart rate levels in group B were significantly lower 15 min after block (p< 0.001). SBP and DBP levels in B group were significantly lower than in A (p < 0.001). No major adverse effects were observed in either of the groups except for sedation 8 and respiratory depression in 6 patients of group A. Conclusion: Supraclavicular brachial plexus block significantly lengthens the onset time of pain and prolongs the duration of post op analgesia. Patients in group B had good quality analgesia with no adverse effects.
Interscalene brachial plexus anesthesia for shoulder surgery: report of a complicated intraoperative course
Journal of Clinical Anesthesia, 2001
We present a case of abrupt hemodynamic and mental status changes that occurred during shoulder surgery. During interscalene anesthesia for rotator cuff repair, there was abrupt onset of altered mental status and hemodynamic changes, which had a variety of possible contributing causes. Complete recovery occurred during care in the post-anesthesia care unit. A variety of physiologic changes can occurred during interscalene anaesthesia for shoulder surgery, which require prompt identification and management.
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