The indications and applications of interscalene brachial plexus block for surgery about the shoulder

Brull, Richard; McCartney, Colin J. L.; Sawyer, Richard; Schroeder, Herbert P. von

doi:10.1016/j.acpain.2004.04.002

Cited by 25 publications

(10 citation statements)

References 121 publications

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“…Interscalene brachial plexus block may be complicated with stellate ganglion block and induce Horner's syndrome [6,18-21]. Spreading of the local anesthetic solution injected, similar to the one observed during other blocks, cannot be excluded [22].…”

Section: Discussionmentioning

confidence: 99%

“…Conflicting data exist about the impact of the use of epinephrine as an additive to the local anesthetic solution [5,7]. As stellate ganglion block is frequently observed along with ISB [6], an association of this block with bradycardia and/or hypotension has been proposed [9]. Furthermore, this extension of the block, from brachial plexus to stellate ganglion, may explain the different incidence of cardiovascular instability between right and left-sided ISBs [2,7].…”

Section: Introductionmentioning

confidence: 99%

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Effect of interscalene brachial plexus block on heart rate variability

Simeoforidou

Vretzakis

Chantzi

et al. 2013

Korean J Anesthesiol

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BackgroundInterscalene brachial plexus block (ISB) may be followed by cardiovascular instability. Until date, there is no clear picture available about the underlying mechanisms of ISB. In this study, we aimed to determine the changes in heart rate variability (HRV) parameters after ISB and the differences between right- and left-sided ISBs.MethodsWe prospectively studied 24 patients operated for shoulder surgery in sitting position and divided them into two respective groups: R (right-sided block = 14 pts) and L (left-sided block = 10 pts). HRV data were taken before and 30 min after the block. Ropivacaine without ephedrine was used for the ISB through an insulated block needle connected to a nerve stimulator. Statistical analysis implemented chi-square, Student's and t-paired tests. Skewed distributions were analyzed after logarithmic transformation.ResultsAll the studied patients had successful blocks. Horner's syndrome signs were observed in 33.3% of the patients (R = 5/14, L = 3/10; [P = 0.769]). There were no significant differences in pre-block HRV between the groups. The application of ISB had differential effect on HRV variables: R-blocks increased QRS and QTc durations and InPNN50, while a statistical decrease was seen in InLF. L-blocks did not show any significant changes. These changes indicate a reduced sympathetic and an increased parasympathetic influence on the heart's autonomic flow after R-block.ConclusionsBased on the obtained results we conclude that ISB, possibly through extension of block to the ipsilateral stellate ganglion, alters the autonomic outflow to the central circulatory system in a way depending on the block's side.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of interscalene brachial plexus block on heart rate variability

Simeoforidou

Vretzakis

Chantzi

et al. 2013

Korean J Anesthesiol

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“…Peripheral nerve stimulator (PNS) is the 'gold standard' for performing peripheral nerve blocks, and it is highly effective technique for determining adequate needle position to produce regional anaesthesia/analgesia. [6][7][8][9] The advantages of using a NS are high incidence of success rate and low cost when compared to US. Although nerve stimulator guidance is the current technique of choice, it may have suboptimal ability to detect intraneural placement.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of ultrasound guided verses nerve stimulator technique of interscalene brachial plexus block: insights from Indian multi-super specialty hospital

et al. 2018

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Background: To provide adequate intraoperative anaesthesia and postoperative analgesia for orthopaedic surgery continues to be a procedural challenge. The administration of brachial plexus anaesthesia can be facilitated through nerve stimulation or by ultrasound guidance. Hence study was conducted to compare differences in these techniques in patients undergoing interscalene brachial plexus block (ISSB).Methods: In this prospective, randomized, observer-blinded study, 60 patients (Male=41, Female=19) were scheduled for orthopaedic shoulder and upper arm surgeries matching inclusion and exclusion criteria. Patients were randomly allocated to either Ultrasound (US, n=30) group or Nerve Stimulator (NS, n=30) group through a computer-generated randomization.Results: There was significant difference between US and NS group with respect to average number of attempts taken, block performance time (BPT), onset of sensory and motor block, duration of motor block and patient satisfaction score. Whereas not much significant difference was observed in duration of sensory block, block success rate and incidence of post operative side effects.Conclusions: The results suggest that US guided ISBB is significantly superior to NS guided block in terms of faster onset of action; lower number of attempts to locate Interscalene brachial plexus; longer duration of block and overall success rate with favourable tolerability at real-life scenario.

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“…Interscalene branchial plexus block has several advantages for patients undergoing shoulder surgery, including excellent anaesthesia, opioid-sparing effects, delayed onset of postoperative pain, shortened postanaesthesia stay and increased patient satisfaction. [1][2][3] Interscalene branchial plexus block via in-dwelling perineural catheter for continuous infusion has revolutionized the practice of acute pain management for shoulder surgery in the postoperative period, since it provides prolonged postoperative analgesia. 2 Spinal anaesthesia has similar advantages, including postoperative analgesia and opioid sparing in orthopaedic surgery.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Interscalene branchial plexus block via in-dwelling perineural catheter for continuous infusion has revolutionized the practice of acute pain management for shoulder surgery in the postoperative period, since it provides prolonged postoperative analgesia. 2 Spinal anaesthesia has similar advantages, including postoperative analgesia and opioid sparing in orthopaedic surgery. [4][5][6] Here, we describe the case of an ISBPB with continuous perineural infusion and concomitant spinal anaesthesia for surgical anaesthesia and postoperative analgesia in a patient with significant medical comorbidities presenting with two long bone fractures.…”

Section: Introductionmentioning

confidence: 99%

Concurrent Open Reduction and Fixation of the Femur and Humerus under Spinal and Ultrasound-guided Interscalene Catheter Anaesthesia in a Cachectic Patient on Haemodialysis

Hoffer¹,

Shyam²

2014

IJPUT

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Purpose: We describe a complex medical case in which an ultrasound-guided interscalene brachial plexus block (ISBPB) was used with continuous perineural infusion and concomitant spinal anaesthesia for surgical anaesthesia and postoperative analgesia in a patient with multiple comorbidities , who required repair of multiple long bone fractures. Materials and methods:The current case report is presented with patient consent and with Institutional Research Ethics Board approval. Results:A 53-year-old female patient with multiple medical comorbidities suffered a fall as a result of a hypoglycemic epi sodeandpresentedforopenreductionandinternalfixation of distal femur fracture and revision of the fractured contralateral proximal humerus. This case was one of complex surgical anaes thesia and analgesia as a result of the patient's significantcomorbiditiesincludingtypeIdiabetes,end-stagerenal disease, peripheral vascular disease, hypertension, severe kyphosis,anaemia,hypothyroidism,gastroesophagealreflux disease, chronic cough, chronic steroid use and multiple phar ma cological sensitivities. The use of an ISBPB using an in-dwelling perineural catheter and concomitant spinal anaesthesia provided appropriate surgical anaesthesia and post-operative analgesia. Conclusion:Our case illustrates the success of an ISBPB with continuous perineural infusion with concurrent spinal anaesthesia for surgical anaesthesia and postoperative analgesia in a patientwithsignificantmedicalcomorbiditiespresentingwith two long bone fractures.

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The indications and applications of interscalene brachial plexus block for surgery about the shoulder

Cited by 25 publications

References 121 publications

Effect of interscalene brachial plexus block on heart rate variability

Effect of interscalene brachial plexus block on heart rate variability

Evaluation of ultrasound guided verses nerve stimulator technique of interscalene brachial plexus block: insights from Indian multi-super specialty hospital

Concurrent Open Reduction and Fixation of the Femur and Humerus under Spinal and Ultrasound-guided Interscalene Catheter Anaesthesia in a Cachectic Patient on Haemodialysis

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