Regional Blockade of the Shoulder: Approaches and Outcomes

Abstract

The article reviews the current literature regarding shoulder anesthesia and analgesia. Techniques and outcomes are presented that summarize our present understanding of regional anesthesia for the shoulder. Shoulder procedures producing mild to moderate pain may be managed with a single-injection interscalene block. However, studies support that moderate to severe pain, lasting for several days is best managed with a continuous interscalene block. This may cause increased extremity numbness, but will provide greater analgesia, reduce supplemental opioid consumption, improve sleep quality and patient satisfaction. In comparison to the nerve stimulation technique, ultrasound can reduce the volume of local anesthetic needed to produce an effective interscalene block. However, it has not been shown that ultrasound offers a definitive benefit in preventing major complications. The evidence indicates that the suprascapular and/or axillary nerve blocks are not as effective as an interscalene block. However in patients who are not candidates for the interscalene block, these blocks may provide a useful alternative for short-term pain relief. There is substantial evidence showing that subacromial and intra-articular injections provide little clinical benefit for postoperative analgesia. Given that these injections may be associated with irreversible chondrotoxicity, the injections are not presently recommended.

Pre- or postoperative interscalene block and/or general anesthesia for arthroscopic shoulder surgery: a retrospective observational study

“…They target nerve roots C4-C6 and thereby provide regional analgesia to the shoulder and upper arm. 1 Although ISBPBs are often performed in combination with general anesthesia (GA) to enhance postoperative analgesia, 2 they are also sometimes used as a sole means of anesthesia. [3][4][5][6] Given the side effects associated with GA (short-term cognitive impairment, somnolence, and postoperative nausea and vomiting [PONV]) that can increase patient morbidity and delay discharge, avoidance of GA has the potential to improve outpatient surgical care.…”

Blinded and stimulator guided comparison of suprascapular nerve block in hemiplegic shoulder pain: a pilot study

“…In addition, the stimulator is affordable, portable and needs less setup time. [29] Compared to other studies, our follow-up period is very short and should be considered as a limitation for our study. However, our primary aim was to compare two techniques, not long-term efficacy.…”

Pain Management in Plastic Surgery

“…There is insufficient evidence for optimal infusion rates, bolus doses on demand, or lockout intervals, although continuous infusion rates of 4-10 ml/h, bolus dose on demand 2-5 ml, and 20-60 min lockout interval have been successfully used. However, there will always be variations between patients, and the regimen should be adjusted to give the desired effect [33,35,37,39,[41][42][43][44][45][46].…”

“…Therefore, if outpatients do not regain control to obtain additional local anesthesia, practitioners experience a dilemma regarding the use of analgesia selected between strong analgesia for a shorter period of time or weaker analgesia for a longer period of time. For the record, the duration of the infusion may be increased by progressively decreasing the basal infusion rate with a programmable infusion pump, thereby theoretically maximizing postoperative analgesia [33,35,37,39,[41][42][43][44][45][46].…”