What is Interscalene Anaesthesia?
An interscalene block is an anesthetic technique. It’s used as a regional anesthetic, and may be combined with a general anesthetic, to block sensations in the shoulder and upper arm before, during, and after surgery.
What is the difference between Interscalene and supraclavicular block?
The increased distance between the supraclavicular injection site and the phrenic nerve compared with the interscalene approach results in a reduced incidence of hemidiaphragmatic paresis. The shoulder joint is mainly innervated by the suprascapular and axillary nerves originating from the brachial plexus.
How do I identify my Interscalene groove?
Palpate the posterior border and then slide your fingers posteriorly and laterally to feel the bellies of the anterior and middle scalene muscles. There is a grove between these muscles called the interscalene grove. This is your goal. You should then trace a line laterally from the cricoid cartilage.
What is the most commonly reported complication in the use of Interscalene regional anesthesia for shoulder surgery?
Other concerns about the routine use of interscalene blocks for shoulder surgery are due to the variable rate of successful block placement, from 84% to 98% according to case series (5, 6), and the possibility of major complications, including inadvertent spinal/epidural anaesthesia, seizure and cardiac arrest (7).
Is an Interscalene block a peripheral nerve block?
The block involves injection of local anesthetic to block the brachial plexus. It is the second most common upper extremity peripheral nerve block performed in outpatient settings, after axillary blocks.
What is Interscalene brachial plexus?
The brachial plexus is a nerve network that supplies the upper extremity. It is formed by C5-T1. It exits the cervical spine and travels between the anterior and middle scalene muscles and then travels distally around the axillary artery. The space between the scalene muscles is called the interscalene groove.
Which nerve is spared in Interscalene block?
The interscalene block covers most of the brachial plexus, sparing the ulnar (C8-T1) nerve. It is a great block for distal clavicle, shoulder, and proximal humerus procedures. Under sterile conditions, the interscalene space is identified either by palpation or ultrasound visualization.
What nerve does Interscalene block?
Which nerves are blocked in Interscalene block?
How long does an Interscalene nerve block last?
The block can last anywhere from 4 to 18 hours, depending on which medicines are used. As with any anesthetic, there are risks and benefits to interscalene blocks.
How long does an Interscalene block last?
The block can last anywhere from 4 to 18 hours, depending on which medicines are used. As with any anesthetic, there are risks and benefits to interscalene blocks. These particulars can be discussed with your anesthesiologist before your surgery.
What are the side effects of an interscalene block?
Horner syndrome is common after interscalene block and consists of ptosis, myosis, and enophthalmia. The most common side effects encountered after interscalene block are hoarseness (10%–20%) due to the blockade of the recurrent laryngeal nerve, which occurs more frequently on the right side.
Can an interscalene block be used for arm surgery?
The interscalene block can also be utilized for surgery of the arm or forearm; however, the higher incidence of incomplete blockade of the inferior trunk with this technique may provide inadequate analgesia in the ulnar distribution.
What kind of pain does an interscalene catheter cause?
TABLE 1. Single-injection vs the choice of technique: interscalene catheter according to surgery. Up to 70% of patients report severe pain on movement after open major shoulder surgery, which is more than after hysterectomy (60%), gastrectomy, or thoracotomy (60%).
What kind of local anesthetic is used for interscalene?
For single-shot techniques, a variety of local anesthetics can be used (Table 4), depending on the desired duration and density of blockade. The typical volume of local anesthetic used for interscalene blocks is 15–20 mL of ropivacaine 0.5% or 0.75%.