Performing an Interscalene Block during General Anesthesia Must Be the Exception

A prospective analysis of interscalene brachial plexus blocks performed under general anesthesia

“…9 Although interscalene anesthesia has become a standard of care in many communities as a means of postoperative pain control, there are several reports that raise serious concerns as to the safety of the procedure. 3,7,34,44 Reported complications of interscalene anesthesia include: seizure, cardiovascular collapse, pneumothorax, intraneural injection, spinal cord injection, brachial plexitis, auditory disturbance, dyspnea secondary to phrenic nerve palsy, chronic Horner's syndrome, pseudo aneurysm, and permanent paresthesias. 1,2,8,9,[11][12][13][14][17][18][19]21,[26][27][28]30,[35][36][37][41][42][43]45 In some anecdotal case reports, authors have expressed a concern that there would likely be an increased risk of serious complications if the procedure were to be performed after induction of general anesthesia.…”

Catastrophic complication of an interscalene catheter for continuous peripheral nerve block analgesia

“…While there is now consensus against such practise, at the time that this case took place the issue was less clear. In 2000, Benumof described four cases of catastrophic spinal cord injury after interscalene block performed under general anaesthesia [7]; his report unleashed a storm of letters to the editor [8–10]. Nevertheless, Benumof noted in his response that performance of regional anaesthesia under general anaesthesia was common practice, rather than the exception [11].…”

Epidurale Fehllage eines interskalenären Plexuskatheters

“…die Injektion gestoppt und so eine noch schwerere Verletzung verhindert werden [2,3,15]. Borgeat et al [5] halten daher die Narkose für eine "nahezu absolute Kontraindikation" der ISRA. …”

“…Eine herausragende Bedeutung für die ISRA-Sicherheit hat die Punktionstechnik [4,5,13,17]. Bei medialer Stichrichtung ist ein direkter Kanüleneintritt in ein Neuroforamen möglich [17].…”