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Interscalene Nerve Block: Difference between revisions
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==Indications== | ==Indications== | ||
*Post operative analgesia for shoulder surgery | *Post operative analgesia for shoulder surgery | ||
*[[Humerus fracture]] | *[[Proximal Humerus Fractures|Humerus fracture]] | ||
* | *Lacerations or abscesses of upper arm and deltoid | ||
* | *Shoulder dislocation | ||
==Contraindications== | ==Contraindications== | ||
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**Due to risk of unilateral pneumothorax | **Due to risk of unilateral pneumothorax | ||
*Overlying infection | *Overlying infection | ||
*Allergy to | *Allergy to anaesthetics | ||
*Phrenic nerve dysfunction | *Phrenic nerve dysfunction | ||
**Specifically contralateral phrenic nerve dysfunction, due to the risk of unilateral paralysis | **Specifically contralateral phrenic nerve dysfunction, due to the risk of unilateral paralysis | ||
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*Ultrasound (linear probe) | *Ultrasound (linear probe) | ||
*Syringe with 25g needle | *Syringe with 25g needle | ||
*5-10cc local | *5-10cc local anaesthetic | ||
==Procedure== | ==Procedure== | ||
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# The anterior and middle scalene muscles lie directly below the edge of the SCM, and the brachial plexus is sandwiched in between the muscles | # The anterior and middle scalene muscles lie directly below the edge of the SCM, and the brachial plexus is sandwiched in between the muscles | ||
# The C5-C7 roots are usually well visualized and resemble a "traffic light" while C8 and T1 roots are variably visualized | # The C5-C7 roots are usually well visualized and resemble a "traffic light" while C8 and T1 roots are variably visualized | ||
# Check with | # Check with colour doppler to ensure no blood vessels in the vicinity | ||
# Insert the needle in the long axis underneath the probe and inject the local anethetic next the the roots after hydrodissecting the roots with test injections | # Insert the needle in the long axis underneath the probe and inject the local anethetic next the the roots after hydrodissecting the roots with test injections | ||
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*Phrenic nerve paralysis<ref>Borgeat A et al. Acute and nonacute complications associated with interscalene block and shoulder surgery: a prospective study. Anesthesiology. 2001 Oct. 95(4):875-80</ref> | *Phrenic nerve paralysis<ref>Borgeat A et al. Acute and nonacute complications associated with interscalene block and shoulder surgery: a prospective study. Anesthesiology. 2001 Oct. 95(4):875-80</ref> | ||
**Causing unilateral diaphragmatic paralysis and respiratory distress. | **Causing unilateral diaphragmatic paralysis and respiratory distress. | ||
* | *Pneumothorax<ref>Auroy Y. et al. Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service. Anesthesiology. 2002 Nov. 97(5):1274-80.</ref> | ||
**On the side of the nerve block | **On the side of the nerve block | ||
==External Links== | ==External Links== | ||
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===Videos=== | ===Videos=== | ||
<youtube>7DRPiS3ZrVo</youtube> | |||
==References== | ==References== |
Latest revision as of 21:44, 4 May 2022
- Provides anesthesia to the shoulder and upper arm.[1]
- Performed by injecting local anesthetic to the nerves of the brachial plexus as it passes through the groove between the anterior and middle scalene muscles, at the level of the cricoid cartilage.
Indications
- Post operative analgesia for shoulder surgery
- Humerus fracture
- Lacerations or abscesses of upper arm and deltoid
- Shoulder dislocation
Contraindications
- Severe lung disease
- Due to risk of unilateral pneumothorax
- Overlying infection
- Allergy to anaesthetics
- Phrenic nerve dysfunction
- Specifically contralateral phrenic nerve dysfunction, due to the risk of unilateral paralysis
Equipment Needed
- Ultrasound (linear probe)
- Syringe with 25g needle
- 5-10cc local anaesthetic
Procedure
- Place the linear probe at the level of the larynx and find the IJ vein and the overlying sternocleidomastoid muscle (SCM)
- Slide the probe laterally until the tapering edge of the SCM is visualized
- The anterior and middle scalene muscles lie directly below the edge of the SCM, and the brachial plexus is sandwiched in between the muscles
- The C5-C7 roots are usually well visualized and resemble a "traffic light" while C8 and T1 roots are variably visualized
- Check with colour doppler to ensure no blood vessels in the vicinity
- Insert the needle in the long axis underneath the probe and inject the local anethetic next the the roots after hydrodissecting the roots with test injections
Complications
- Phrenic nerve paralysis[2]
- Causing unilateral diaphragmatic paralysis and respiratory distress.
- Pneumothorax[3]
- On the side of the nerve block
External Links
Videos
References
- ↑ Ullah H. et al. Continuous interscalene brachial plexus block versus parenteral analgesia for postoperative pain relief after major shoulder surgery. Cochrane Database Syst Rev. 2014 CD007080
- ↑ Borgeat A et al. Acute and nonacute complications associated with interscalene block and shoulder surgery: a prospective study. Anesthesiology. 2001 Oct. 95(4):875-80
- ↑ Auroy Y. et al. Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service. Anesthesiology. 2002 Nov. 97(5):1274-80.