Indications: - When compared with placebo in patients undergoing "major shoulder surgery", interscalene block with a patient-controlled catheter system or an ambulatory continous interscalene nerve block significantly reduced the consumption of rescue medication after surgery (1,2). Interscalene block was found to be associated with less need for intraoperative opioids (1).
Complications: - The incidence of persistent neurological complications ranged from 0-4.4%, with a high incidence of hoarseness (31% of 515 patients, duration 2 days), Horner's syndrome and dyspnea (10% of 515 patients, duration 2 days) (1,3,5).
- No conversion to general anesthesia in 515 patients (1,5).
Treatment: - Adequate postoperative analgesia and a reduced incidence of diaghragmatic block can be obtained using from 2.3 to 4.3 ml of bupivacain 0.5% with epinephrin (1:200000) (1,4).
References: - J. Kessler et al. Peripheral regional anaesthesia and outcome: lessons learned from the last 10 years. British Journal of Anaesthesia. 2015;114(5):728-45: full text | pdf.
- Goebel S. et al. Interscalene brachial plexus block for open-shoulder surgery: a randomized, double-blind, placebo-controlled trial between single-shot anaesthesia and patient-controlled catheter system. Arch Orthop Trauma Surg. 2010; 130:533-40: full text | pdf.
- Faryniarz D. et al. Interscalene block anaesthesia at an ambulatory surgery center performing predominantly regional anaesthesia: a prospective study of one hundred thirty-three patients undergoing shoulder surgery. J Shoulder Elbow Surg. 2006;15:686-90: full text | pdf.
- Falcao LF et al. Minimum effective volume of 0.5% bupivacaine with epinehrine in ultrasound-guided interscalene brachial plexus block. Br J Anaesth. 2013;110:450-5: full text | pdf.
- Liu SS et al. A prospective clinical registry of ultrasound-guided regional anaesthesia for ambulatory shoulder surgery. Anaesth Analg. 2010;111:617-23: full text | pdf.
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