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Nerve block: Intrascalene
From WikEM
Contents
Overview
- Provides anesthesia to the shoulder and upper arm.[1]
Indications
- Post operative analgesia for shoulder surgery
- Humerus fracture
- Lacerations or abscesses of upper arm and deltoid
- Shoulder dislocation
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
- Ultrasound (linear probe)
- Syringe with 25g needle
- 5-10cc local anesthetic
Procedure
- Place the linear probe at the level of the larynx and find the IJ vein and the overlying sternocleidomastoid muscle (SCM)
- Slide the probe laterally until the tapering edge of the SCM is visualized
- The anterior and middle scalene muscles lie directly below the edge of the SCM, and the brachial plexus is sandwiched in between the muscles
- The C5-C7 roots are usually well visualized and resemble a "traffic light" while C8 and T1 roots are variably visualized
- Check with color doppler to ensure no blood vessels in the vicinity
- Insert the needle in the long axis underneath the probe and inject the local anethetic next the the roots after hydrodissecting the roots with test injections
Complications
- Phrenic nerve paralysis[2]
- Causing unilateral diaphragmatic paralysis and respiratory distress.
- Pneumothorax[3]
- On the side of the nerve block
See Also
External Links
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.
