ANESTHESIA FOR SHOULDER PROCEDURES: THE

INTERSCALENE BRACHIAL PLEXUS BLOCK

Shannon Bachman RN, BSN, SRNA

York College of Pennsylvania/ WellSpan Health Nurse Anesthesia Program

Class of 2015

ObjectivesBrief nod to Alon P.

Winnie Interscalene Brachial

Plexus Block vs. General Anesthesia

Ultrasound Guided vs. PNS Technique

Local Anesthetic Volumes

Adverse EventsCase Study:

Interscalene Catheter

Alon P. Winnie

Winnie Technique

ISB vs. GA: The Data

I’m so happy!!!!

Argg blahhh…

ISB vs. GA: The Data

“…with 30% of patients reporting severe pain on the first postoperative day… [may result

in] unplanned overnight admission…”

ISB: PNS vs. Ultrasound guided

Phrenic Nerve

Volume

Volume cont.

Adverse Events #1. Mid Scalene#2. Ant Scalene#5. Phrenic Nerve#6.Brachial Plexus1

2

56

Case report: “…different and sometimes devastating complications have been reported relating to either needle or catheter insertion or to the administration of local anaesthetic.”

References:• Danelli, G., Bonarelli, S., Tognu, A., Ghisi, D., Fanelli, A., Biondini, S.,...Fanelli, G. (2012). Prospective randomized comparison

of ultrasound-guided and neurostimulation techniques for continious interscalene brachial plexus block in patients undergoing coracoacromial ligament repair. British Journal of Anaesthesia, 108(6), 1006-1010.

• Gonano, C., Kettner, S. C., Ernstbrunner, M., Schebesta, K., Chiari, A., & Marhofer, P. (2009). Comparison of economical aspects of interscalene brachial plexus blockade and general anaesthesia for arthroscopic shoulder surgery. British Journal of Anaesthesia, 103(3), 428-433.

• Hadzic, A., Williams, B. A., Karaca, P. E., Hobeika, P., Unis, G., Dermksian, J.,...Santos, A. C. (2005). For outpatient rotator cuff surgery, nerve block anesthesia provides surerior same-day recovery ver general anesthesia. Pain and Regional Anesthesia, 102, 1001-1007.

• Jeng, C. L., Torrillo, T. M., & Rosenblatt, M. A. (2010). Complications of peripheral nerve blocks. British Journal of Anaesthesia, 105(51), 97-107.

• Liu, S. S., YaDeau, J. T., Shaw, P. M., Wilfred, S., Shetty, T., & Gordon, M. (2011). Incidence of unintentional intraneural injection and postoperative neurological complications with ultrasound-guided interscalene and supraclavicular nerve blocks. Anaesthesia, 66, 168-174.

• Manavi, M. (2010). Lipid infusion as a treatment for local anesthetic toxicity: A literature review. AANA Journal, 78(1), 69- 78.• McNaught, A., Shastri, U., Carmichael, N., Awad, I. T., Columb, M., Cheung, J.,...McCartney, C. J. (2010). Ultrasound reduces

the minimum effective local anaesthetic volume compared with peripheral nerve stimulation for interscalene block. British Journal of Anaesthesia, 106(1), 124-130.

• Ptaszynski, A. E., Horlocker, T. T., Bacon, D. R., & Rowlingson, J. C. (2006). Alon P. Wimmie, L. Donald Bridenbaugh, Jk., Harold Carron, P. Prithvi Raj, and Jordan Katz: Founding fathers of the American Society of Regional Anesthesia. Regional Anesthesia and Pain Medicine, 31(1), 71-78.

• Riazi, S., Carmichael, N., Awad, I., Holtby, R. M., & McCartney, C. J. (2008). Effect of local anaesthetic volume (20vs 5ml) on the efficacy and respiratory consequences of ultrasound-guided interscalene brachial plexus block. British Journal of Anaesthesia, 101(4), 549-556.

• Verela, H., & Burns, S. M. (2010). Use of lipid emulsions for treatment of local anesthetic toxicity: A case report. American Association of Nurse Anesthetists , 78(5), 359-364.

• Winnie, A. P. (1970). Interscalene Brachial Plexus Block. Anesthesia and Analgesia, 49(3), 455-466. • Yanovski, B., Gaitni, L., Volodarski, D., & Ben-David, B. (2012). Catastrophic complication of an interscalene catheter for

continious peripheral nerve block analgesia. Anaesthesia, 67, 1166-1169. • Yauger, Y. J., Bryngelson, J. A., Donohue, K., Lawhorn, L. A., Pitcher, B. M., Schoneboom, B. M., & Watts, D. D. (2010). Patient

outcomes comparing CRNA-admnistered peripheral nerve blocks and general anesthesia: A retrospective chart revew in a US Army same-day surgery center. American Association of Nurse Anesthesia, 78(3), 215-220.