A Comparison of Combined Suprascapular and Axillary Nerve Blocks to Interscalene Block

The article reviews the current literature regarding shoulder anesthesia and analgesia. Techniques and outcomes are presented that summarize our present understanding of regional anesthesia for the shoulder. Shoulder procedures producing mild to moderate pain may be managed with a single-injection interscalene block. However, studies support that moderate to severe pain, lasting for several days is best managed with a continuous interscalene block. This may cause increased extremity numbness, but will provide greater analgesia, reduce supplemental opioid consumption, improve sleep quality and patient satisfaction. In comparison to the nerve stimulation technique, ultrasound can reduce the volume of local anesthetic needed to produce an effective interscalene block. However, it has not been shown that ultrasound offers a definitive benefit in preventing major complications. The evidence indicates that the suprascapular and/or axillary nerve blocks are not as effective as an interscalene block. However in patients who are not candidates for the interscalene block, these blocks may provide a useful alternative for short-term pain relief. There is substantial evidence showing that subacromial and intra-articular injections provide little clinical benefit for postoperative analgesia. Given that these injections may be associated with irreversible chondrotoxicity, the injections are not presently recommended.

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A COMPARATIVE STUDY BETWEEN INTERSCALENE BLOCK AND SUPRASCAPULAR PLUS AXILLARY NERVE BLOCK IN PATIENTS UNDERGOING SHOULDER SURGERY

10.36106/ijsr/0217008 ◽

2021 ◽

pp. 72-74

Author(s):

Swati Dutta ◽

Sudakshina Mukherjii ◽

Manjushree Ray ◽

Gautam Lahiri ◽

Arup Chakraborty

Keyword(s):

Nerve Block ◽

Visual Analog Scale Score ◽

Axillary Nerve ◽

Shoulder Surgery ◽

Interscalene Block ◽

Block Group ◽

Nerve Blocks ◽

Number Of Patients ◽

Axillary Nerve Block

The interscalene block is the gold standard for shoulder anesthesia. The suprascapular nerve block combined with an axillary nerve block may provide an efcacious alternative to the interscalene nerve block for shoulder surgery. To compare interscalene block with suprascapular plus axillary nerve block for shoulder surgery in terms of quality of anaesthesia, duration of analgesia and, associated complications. Seventy one patients were randomly allocated in two groups to receive either interscalene block (Group IG, number of patients =35) or suprascapular plus axillary nerve block (Group SG, number of patients = 36). Onset of block, quality of block, failure rate and incidence of complications were observed. Postoperative pain was assessed by Visual Analog Scale. Score ≥4 was considered as signicant pain and, rescue analgesic injection tramadol 100 mg was administered. Onset of sensory block was 17.67±6.11 min and 15.29±1.72 min in group SG and IG respectively. Similarly duration of block was 247.61±78.46 min (Group SG) and 268.11±24.78 min (Group IG) (p=0.1332). Majority of patients had grade III motor block in group IG (74%) and grade II in group SG (89%). Three patients had either partial or complete failure of block in SG group. Interscalene block provided longer duration of postoperative analgesia. Both interscalene block and suprascapular plus axillary nerve block provide effective anaesthesia and analgesia for shoulder surgery. Although quality of block is better following interscalene block; suprascapular and axillary nerve blocks are associated with fewer side effects.

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Postoperative analgesia for arthroscopic shoulder surgery: comparison between ultrasound-guided interscalene block and combined suprascapular and axillary nerve blocks

Ain-Shams Journal of Anaesthesiology ◽

10.4103/1687-7934.198260 ◽

2016 ◽

Vol 9 (4) ◽

pp. 536 ◽

Cited By ~ 2

Author(s):

Abdalla Waleed

Keyword(s):

Postoperative Analgesia ◽

Axillary Nerve ◽

Shoulder Surgery ◽

Interscalene Block ◽

Ultrasound Guided ◽

Nerve Blocks ◽

Arthroscopic Shoulder Surgery

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Shingles Following Axillary Nerve Block a Case Report

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_86_90030-6 ◽

1986 ◽

Vol 11 (1) ◽

pp. 115-116

Author(s):

N. J. PERCIVAL

Keyword(s):

Case Report ◽

Herpes Zoster ◽

Nerve Block ◽

Upper Limb ◽

Axillary Nerve ◽

Nerve Blocks ◽

Upper Limb Surgery ◽

Axillary Nerve Block

Axillary nerve blocks are now frequently used for emergency and elective upper limb surgery. The method gives reliable anaesthesia with few complications. A case is described in which a patient developed Herpes Zoster following an Axillary Nerve Block, a hitherto unreported complication.

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Selective Suprascapular and Axillary Nerve Block Provides Adequate Analgesia and Minimal Motor Block. Comparison with Interscalene Block

Brazilian Journal of Anesthesiology (English Edition) ◽

10.1016/j.bjane.2012.04.002 ◽

2013 ◽

Vol 63 (1) ◽

pp. 45-51 ◽

Cited By ~ 1

Author(s):

Patrícia Falcão Pitombo ◽

Rogério Meira Barros ◽

Marcos Almeida Matos ◽

Norma Sueli Pinheiro Módolo

Keyword(s):

Nerve Block ◽

Motor Block ◽

Axillary Nerve ◽

Interscalene Block ◽

Axillary Nerve Block

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Brachial Plexus Anatomy: Normal and Variant

The Scientific World JOURNAL ◽

10.1100/tsw.2009.39 ◽

2009 ◽

Vol 9 ◽

pp. 300-312 ◽

Cited By ~ 36

Author(s):

Steven L. Orebaugh ◽

Brian A. Williams

Keyword(s):

Brachial Plexus ◽

Relevant Literature ◽

Axillary Nerve ◽

Cochrane Library ◽

Anatomic Variations ◽

Normal Anatomy ◽

Nerve Blocks ◽

Mesh Terms ◽

Brachial Plexus Blockade ◽

Real Time Ultrasonography

Effective brachial plexus blockade requires a thorough understanding of the anatomy of the plexus, as well as an appreciation of anatomic variations that may occur. This review summarizes relevant anatomy of the plexus, along with variations and anomalies that may affect nerve blocks conducted at these levels. The Medline, Cochrane Library, and PubMed electronic databases were searched in order to compile reports related to the anatomy of the brachial plexus using the following free terms: "brachial plexus", "median nerve", "ulnar nerve", "radial nerve", "axillary nerve", and "musculocutanous nerve". Each of these was then paired with the MESH terms "anatomy", "nerve block", "anomaly", "variation", and "ultrasound". Resulting articles were hand searched for additional relevant literature. A total of 68 searches were conducted, with a total of 377 possible articles for inclusion. Of these, 57 were found to provide substantive information for this review. The normal anatomy of the brachial plexus is briefly reviewed, with an emphasis on those features revealed by use of imaging technologies. Anomalies of the anatomy that might affect the conduct of the various brachial plexus blocks are noted. Brachial plexus blockade has been effectively utilized as a component of anesthesia for upper extremity surgery for a century. Over that period, our understanding of anatomy and its variations has improved significantly. The ability to explore anatomy at the bedside, with real-time ultrasonography, has improved our appreciation of brachial plexus anatomy as well.

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An anatomic and clinical study of the suprascapular and axillary nerve blocks for shoulder arthroscopy

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2011.04.022 ◽

2011 ◽

Vol 20 (7) ◽

pp. 1061-1068 ◽

Cited By ~ 34

Author(s):

Yong-Seok Nam ◽

Jae-Jung Jeong ◽

Seung-Ho Han ◽

Sang-Eun Park ◽

Sang-Mook Lee ◽

...

Keyword(s):

Clinical Study ◽

Shoulder Arthroscopy ◽

Axillary Nerve ◽

Nerve Blocks

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Interscalene block in an anesthetized adult with hypertrophic obstructive cardiomyopathy undergoing clavicle fracture reduction

POCUS Journal ◽

10.24908/pocus.v5i1.14223 ◽

2020 ◽

Vol 5 (1) ◽

pp. 6-9

Author(s):

Anthony M.-H. Ho, MD, FRCPC, FCCP ◽

Joel Parlow, MD, FRCPC ◽

Rene Allard, MD, FRCPC ◽

Michael McMullen, MD, FRCPC ◽

Glenio B. Mizubuti, MD, MSc

Keyword(s):

General Anesthesia ◽

Clavicle Fracture ◽

Hypertrophic Obstructive Cardiomyopathy ◽

Left Ventricular ◽

Fracture Repair ◽

Interscalene Block ◽

Ultrasound Guided ◽

Nerve Blocks ◽

Mitral Valve Leaflet ◽

Left Ventricular Outflow

Whether regional anesthesia procedures should be performed in heavily sedated/anesthetized adults remains controversial. One of the purported advantages of performing regional nerve blocks in conversant patients is early warning against major nerve injury and, arguably, early detection of local anesthetic systemic toxicity. A 60-year-old man with hypertrophic obstructive cardiomyopathy (HOCM) underwent a clavicle fracture repair under general anesthesia. Intraoperative transesophageal echocardiography revealed dynamic left ventricular outflow track obstruction and systolic anterior motion of the posterior mitral valve leaflet. In part based on such echo findings, he received an ultrasound-guided interscalene plus a superficial cervical plexus block for postoperative analgesia prior to emergence from general anesthesia. Given the lack of robust data on the safety of ultrasound-guided regional techniques in heavily sedated/anesthetized adults, we use the example of echographic evidence of significant HOCM to argue for a pragmatic and individualized approach when faced with unusual situations in which the pros of such an approach may outweigh the cons – in this case for performing an interscalene block on an anesthetized adult.

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