1,721,294 research outputs found
Pourfour Du Petit syndrome after interscalene block
No full textInterscalene block is commonly associated with reversible ipsilateral phrenic nerve block, recurrent laryngeal nerve block, and cervical sympathetic plexus block, presenting as Horner′s syndrome. We report a very rare Pourfour Du Petit syndrome which has a clinical presentation opposite to that of Horner′s syndrome in a 24-year-old male who was given interscalene block for open reduction and internal fixation of fracture upper third shaft of left humerus
Posterior Interscalene Block: An Ultrasound-Guided Case Series and Overview Of History, Anatomy and Techniques
Full text linkBACKGROUND: The posterior interscalene block has been described as an alternative to the lateral interscalene block. However, this technique has not gained popularity because of the close proximity of the approach to vascular and central neural structures
Persistent phrenic palsy following interscalene block, leading to chronic respiratory insufficiency and requiring long-term non-invasive ventilation
No full textSummaryA persistent phrenic palsy after interscalene block is a rare but possibly severe complication particularly in patients with previous lung function impairment or co-morbidities. We report the case of a patient, with a past history of post-traumatic diaphragmatic eventration, who presents a persistent respiratory insufficiency leading to long term non-invasive ventilation following interscalene block for rotator cuff shoulder surgery. A preoperative careful evaluation of patients addressed to interscalene block could avoid such long term complications
Spinal accessory nerve injury after continuous interscalene block for shoulder arthroscopy in the sitting position
No full textDespite the development of ultrasound-guided techniques in regional anaesthesia, unintentional intraneural injections with neurological complications still occur. We report a case of spinal accessory nerve injury after continuous interscalene block and general anaesthesia for shoulder arthroscopy in the sitting position. Our report alerts the anaesthetist to the potential risk of this injury during ultrasound-guided interscalene block and encourages them to avoid a high posterior puncture site
A comparative study between usg guided classical interscalene block and low approach interscalene block in shaft humerus surgery
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Background:Classical interscalene approach of Brachial plexus block has become the anesthetic technique of choice in upper arm and shoulder surgery but one of the principal concerns is high risk of complications and sparing of C8-T1 nerve roots. Here we used low approach of interscalene block for shaft humerus surgeries. Previously none of the study compare USG guided LISB to the conventional approach for shaft humerus surgeries, Hence, this study was designed to compare onset, duration, density of sensory-motor block, severity of complication between ISB and LISB. Materials and Methods:Patients with fracture of shaft humerus at the age group of 18yrs- 55yrs of three hundred twenty four, ASA I and II patients, were randomly assigned into two groups I and L, where Classicle Interscalene block and Low Interscalene block were used, respectively. The primary objective of the study was to find out the difference in density of sensory-motor blockade and severity of complications if any, between the two groups, by using the Group differences were analyzed by parametric (t test) and nonparametric (Wilcoxon rank order test) tests; 2 was used for tests of independence.Results: At five minutes and fifteen minutes after the performance of the block, the degree of the block in the ulnar nerve was found to be 2.8 ± 2.6 and 1.1 ± 1.8, respectively, based on a ten-point scale. Motor block occurred in the median nerve after fifteen minutes in 151 patients out of 162 (92.8%), and in all of the other three nerves in all 162 patients. Horner syndrome and hoarseness were less frequent in LISB patients than in ISB patients (P 0.0009 and 0.003, respectively) which was statistically significant. Conclusion:The present study confirmed the achievement of an appropriate sensory and motor block in the shaft humerus surgery, including the ulnar nerve, fifteen minutes after LISB, with no complications than ISB
Interscalene Block in the Modern Era: When Stuck, Go Back to the Roots!
Full text linkThe traditional interscalene block has evolved over time to lower, lateral and posterior approaches, coinciding with the advent of Peripheral Nerve Stimulator and Ultrasonography. In limited infrastructure settings, such technology remains elusive and the classical paresthesia technique comes to the rescue. This approach is however very difficult to elicit in pediatric patients. It is here that the grassroot approach of a fascial “click” or “pop” emerges as the savior to administer a satisfactory block. We describe a case of a young boy with successful conduct of anaesthesia for K wire fixation of supracondylar fracture of humerus under lower interscalene block with loss of resistance technique. In light of recent research showing about 40-50% variation in the brachial plexus anatomy around the subclavian artery, use of technology in anaesthesia is the future. However, till such technology is made universally affordable, it is pertinent to remember the roots of interscalene block
Posterior Interscalene Block: An Ultrasound-Guided Case Series and Overview Of History, Anatomy and Techniques
Full text linkBACKGROUND: The posterior interscalene block has been described as an alternative to the lateral interscalene block. However, this technique has not gained popularity because of the close proximity of the approach to vascular and central neural structures.OBJECTIVE: To describe the posterior interscalene block technique using ultrasound imaging, and to review the history of its evolution.METHODS: The use of ultrasound imaging to facilitate the insertion of interscalene catheters using the posterior approach in 11 patients undergoing total shoulder arthroplasty is described.RESULTS: All 11 patients had satisfactory analgesia in the first 24 h of the postoperative period. None of the patients complained of neck pain, as had been found in earlier techniques using the posterior approach.CONCLUSIONS: This modification of the posterior approach is a safe and effective method for the insertion of interscalene brachial plexus catheters. These catheters are also comfortable for patients and, in the present study, none of the catheters inadvertently fell out.Peer Reviewe
Perioperative Management of Interscalene Block in Patients with Lung Disease
Full text linkInterscalene nerve block impairs ipsilateral lung function and is relatively contraindicated for patients with lung impairment. We present a case of an 89-year-old female smoker with prior left lung lower lobectomy and mild to moderate lung disease who presented for right shoulder arthroplasty and insisted on regional anesthesia. The patient received a multimodal perioperative regimen that consisted of a continuous interscalene block, acetaminophen, ketorolac, and opioids. Surgery proceeded uneventfully and postoperative analgesia was excellent. Pulmonary physiology and management of these patients will be discussed. A risk/benefit discussion should occur with patients having impaired lung function before performance of interscalene blocks. In this particular patient with mild to moderate disease, analgesia was well managed through a multimodal approach including a continuous interscalene block, and close monitoring of respiratory status took place throughout the perioperative period, leading to a successful outcome
Sudden developing convulsion during interscalene block: Does propofol anesthesia diminish plasma bupivacaine level?
No full textWe aim to review local anesthetic systemic toxicity (LAST) due to suddenly developing convulsion during interscalene block in a 67-year-old patient undergoing shoulder surgery
Interscalene block for shoulder surgery
Full text linkFracture dislocation of the shoulder is a common musculoskeletal injury
following road traffic accident. Peripheral nerve block has become a
recognized anesthetic technique due to the rapid onset of prolonged
analgesia, sufficient for both pain and surgical management. However,
interscalene block for shoulder surgery has not been reported as a
primary anesthetic technique in our environment. We report its
successful use in open reduction and internal fixation of left humeral
surgical neck fracture dislocation. The interscalene brachial plexus
were localized by a Polystim II nerve stimulator (te me na, Bondy,
France) with sustained biceps motor response at 0.2 mA and 40 ml of
local anesthetic, comprising 0.25% bupivacaine and 1.0% of lidocaine
with 1 : 200 000 epinephrine in equal parts was administered to
establish the block. Surgical anesthesia was achieved 18 minutes after
instituting the block and surgery lasted 70 minutes without
complications. This technique may obviate the use of general anesthesia
with its risks
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