Anesthesia for Shoulder Surgery: A Review of the Interscalene Block and a Discussion of Regional vs. General Anesthesia

Ghaleb, Ahmed; Dilley, Joshua D.

doi:10.2174/1874321801206010018

Cited by 3 publications

(4 citation statements)

References 87 publications

(91 reference statements)

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“…The anesthetic choice depends essentially on several factors: the wishes of the patient, the desires of the surgeon, the skill of the anesthesiologist and patient's characteristics [2], without forgetting surgical factors. In fact, minor surgical procedures can usually be performed using regional anesthesia alone, while a combination of general and regional anesthesia is considered more suitable in the case of longer duration surgery [4].…”

Section: The Evolution From General Anesthesia (Ag) To Regional Anest...mentioning

confidence: 99%

“…This was an effective, technically simple, and safe way of anesthetizing the brachial plexus. Then, interscalene brachial plexus block become more and more popular [2].…”

Section: The Interscalene Brachial Plexus Block (Isb)mentioning

confidence: 99%

“…Although the exact number of total shoulder procedures performed each year is unknown, it is evident that the amount is very relevant [2]; moreover, there is a wide variety of patients who are candidates for shoulder surgery, from the healthy, strong patient affected by sports injury requiring a stabilization procedure, to the weak, aged patients with arthritic complications and trauma [3], who requires joint decompression or arthroplasty [4].…”

Section: Introductionmentioning

confidence: 99%

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Evolution of Anesthetic Techniques for Shoulder Surgery: A Narrative Review

et al. 2022

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Shoulder surgery has radically evolved within the last 70 years, from a marginal orthopedic sub-specialty to an area of great research and advancement; consequently, anesthetic techniques have undergone important development. In fact, a wide variety of anesthetic strategies have emerged, to provide anesthesia and post-operative analgesia: general anesthesia (GA), regional anesthesia (RA), or combined GA and RA. A literature review on online databases was carried out about the different anesthetic approaches for shoulder surgery and their evolution through the years, taking in consideration papers from 1929 to 2021. A comprehensive preoperative assessment of patients undergoing shoulder surgery allows to identify and modify potential risk factors and complications of general anesthesia. Moreover, the use of ultrasound-guided regional blocks could improve the effectiveness of these techniques and bring better postoperative outcomes. Anesthetic management for shoulder surgery has progressed drastically during the last century. More studies are needed to finally standardize anesthetic techniques for specific procedure.

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Section: The Evolution From General Anesthesia (Ag) To Regional Anest...mentioning

confidence: 99%

“…This was an effective, technically simple, and safe way of anesthetizing the brachial plexus. Then, interscalene brachial plexus block become more and more popular [2].…”

Section: The Interscalene Brachial Plexus Block (Isb)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evolution of Anesthetic Techniques for Shoulder Surgery: A Narrative Review

et al. 2022

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“…Regional anaesthesia has become an increasingly common method used to control this pain, either as the primary anaesthetic or as an adjunct to general anaesthesia (GA) [ 6 ]. Compared to GA alone, regional anaesthesia has shown to increase patient satisfaction while achieving similar pain scores [ 7 , 8 ]. In addition, the introduction of these peripheral nerve blocks has reduced postoperative opioid consumption and, consequently, opioid-related side effects such as nausea and respiratory depression [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of Peripheral Nerve Block Technique on Incidence of Phrenic Nerve Palsy in Shoulder Surgery

Campbell,

Johnson,

O’Connor

2023

Anesthesiology Research and Practice

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Peripheral nerve blocks are an increasingly common method of providing postoperative analgesia for shoulder surgeries. However, the standard technique, the interscalene block (ISB), inevitably causes hemidiaphragmatic paresis (HDP), secondary to phrenic nerve palsy. This can cause morbidity in patients with preexisting respiratory compromise, prompting investigation into alternative “phrenic-sparing” nerve blocks. The aim of this review was to give an overview of these blocks and critically evaluate the current literature to determine if any are suitable replacements for ISB. The incidence of HDP and analgesic efficacy were considered. We queried four electronic databases and one register. Twenty-eight original articles were selected for review. The use of ultrasound guidance, lower volumes of local anaesthetic (LA), and injection 4 mm outside the brachial plexus fascia reduced HDP incidence for the ISB; however, no single modification did so sufficiently. While the anterior suprascapular nerve block (SSNB) showed comparable analgesic effects to the ISB, HDP prevalence was also high. The posterior SSNB produced consistently low HDP incidences but also inferior analgesia to ISB, except when combined with an infraclavicular brachial plexus block. The superior trunk block (STB) provided equivalent analgesia to the ISB while reducing HDP incidence, but not significantly. Lower LA volumes consistently led to lower HDP incidence across all blocks, likely due to a reduced ability to spread to the phrenic nerve. Further investigation into the minimum effective volumes of the extrafascial ISB, anterior SSNB, STB, and combined posterior SSNB with infraclavicular block is warranted to determine if any of these blocks can successfully balance HDP prevention with analgesic efficacy.

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Current Concepts in Anaesthesiaand Analgesia for Shoulder Surgery

Ray

Magda

2021

ijsr

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Shoulder surgery varies from simple diagnostic arthroscopy to major total shoulder arthroplasty. Patients present for shoulder surgery may be young and t with a sports injury or elderly sick with rheumatoid arthritis need arthroplasty of the shoulder joint. Choice of anaesthesia based on the type of surgery, and the comorbidity of a patient. Management of severe postoperative pain is a major challenge for the anaesthesiologist. Regional anaesthetic techniques effectively control static as well as dynamic pain and facilitate early mobilization. However regional blocks are not free from the side effects or complications

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Anesthesia for Shoulder Surgery: A Review of the Interscalene Block and a Discussion of Regional vs. General Anesthesia

Cited by 3 publications

References 87 publications

Evolution of Anesthetic Techniques for Shoulder Surgery: A Narrative Review

Evolution of Anesthetic Techniques for Shoulder Surgery: A Narrative Review

Impact of Peripheral Nerve Block Technique on Incidence of Phrenic Nerve Palsy in Shoulder Surgery

Current Concepts in Anaesthesiaand Analgesia for Shoulder Surgery

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