Nerve block: Intrascalene: Difference between revisions
Stephenbrown (talk | contribs) (expanded previous material, provided link with much more in depth instruction/videos/photos) |
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*Post operative analgesia for shoulder surgery | *Post operative analgesia for shoulder surgery | ||
*[[Humerus fracture]] | *[[Humerus fracture]] | ||
* Lacerations or abscesses of upper arm and deltoid | *Lacerations or abscesses of upper arm and deltoid | ||
==Contraindications== | ==Contraindications== | ||
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**Specifically contralateral phrenic nerve dysfunction, due to the risk of unilateral paralysis | **Specifically contralateral phrenic nerve dysfunction, due to the risk of unilateral paralysis | ||
==Equipment Needed== | ==Equipment Needed== | ||
* Linear Probe | *Linear Probe | ||
* 25 g needle | *25 g needle | ||
* 5-10cc local anesthetic | *5-10cc local anesthetic | ||
==Procedure== | ==Procedure== | ||
* Always check for the transverse cervical artery using color Doppler. | *Always check for the transverse cervical artery using color Doppler. | ||
* Keep needle tip as far from the nerve roots as possible. | *Keep needle tip as far from the nerve roots as possible. | ||
* Assume phrenic paralysis and avoid in patients with tenuous respiratory status. | *Assume phrenic paralysis and avoid in patients with tenuous respiratory status. | ||
==Complications== | ==Complications== | ||
Revision as of 18:02, 27 October 2016
Overview
An interscalene nerve block is a regional anesthesia technique, usually performed under ultrasound guidance to provide anesthesia to the shoulder and the upper arm.[1]
Indications
- Post operative analgesia for shoulder surgery
- Humerus fracture
- Lacerations or abscesses of upper arm and deltoid
Contraindications
- Severe lung disease
- Due to risk of unilateral pneumothorax
- Overlying infection
- Allergy to anesthetics
- Phrenic nerve dysfunction
- Specifically contralateral phrenic nerve dysfunction, due to the risk of unilateral paralysis
Equipment Needed
- Linear Probe
- 25 g needle
- 5-10cc local anesthetic
Procedure
- Always check for the transverse cervical artery using color Doppler.
- Keep needle tip as far from the nerve roots as possible.
- Assume phrenic paralysis and avoid in patients with tenuous respiratory status.
Complications
- Phrenic nerve dysfunction[2]
- Causing unilateral diaphragmatic paralysis and respiratory distress.
- Pneumothorax[3]
- On the side of the nerve block
See Also
External Links
Great instructional page from Highland on the intrascalene nerve block http://highlandultrasound.com/interscalene-block/
References
- ↑ Ullah H. et al. Continuous interscalene brachial plexus block versus parenteral analgesia for postoperative pain relief after major shoulder surgery. Cochrane Database Syst Rev. 2014 CD007080
- ↑ Borgeat A et al. Acute and nonacute complications associated with interscalene block and shoulder surgery: a prospective study. Anesthesiology. 2001 Oct. 95(4):875-80
- ↑ Auroy Y. et al. Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service. Anesthesiology. 2002 Nov. 97(5):1274-80.