We consider the modified ISB with catheter a safe and effective procedure for anaesthesia and postoperative pain management of open and closed shoulder surgery.
The interscalene brachial plexus block with and without a catheter has become an indispensable method for anaesthesia and analgesia in shoulder surgery. Not only thorough knowledge of anatomy, but also accurate indication assessment and discussion with the surgeon regarding the location of access, is essential for the successful practice of this technique. Important and practical tips for implementation should especially help the less experienced, with special emphasis on correct positioning of the patient for surgery to avoid iatrogenic neural damage. Preoperative counselling of inevitable side-effects of the technique enhances the patient's acceptance and satisfaction.
This study assesses a modified approach for suprascapular nerve block in a single shot and continuous catheter technique for the treatment of chronic shoulder pain. After thorough anatomic examinations, a new technique was performed in 30 patients by inserting the catheter into the suprascapular fossa. Complications of the technique, time of onset, effect and patient satisfaction were evaluated. The results show that there were no complications due to the technique and only one patient had a minor VAS score during physiotherapeutic exercise. Local inflammation occurred in one patient and dislocation of the catheter in another patients. Patient satisfaction (97%) was very high. The modified technique of continuous suprascapular nerve block is a safe and easy-to-perform technique in the treatment of acute and chronic shoulder pain.
We report on a case of an unexpected gas embolism during an arthroscopy of a newly injured shoulder joint. We used carbon dioxide as an arthroscopic medium which has not been considered hazardous up to now. The sudden decrease of the endtidal CO2 concentration in connection with a decrease of peripheral oxygen saturation as well as the clinical symptoms led to an immediate diagnosis of gas embolism. In this case external cardiac massage and aspiration of gas from the right ventricle proved an effective treatment.
The axillary brachial plexus block is a very safe, but sometimes unreliable technique for anaesthesia of the upper extremities. Alternative methods like the infraclavicular block offer a higher success rate, but also the possibility of severe complications. We suggest a modified axillary technique with an injection site medial to the artery, evaluated by clinical experience and anatomical investigations, which could solve the problem of high failure rate, especially in the area of the radial nerve while still maintaining patient safety.
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