The Interscalene Brachial Plexus Block
Regional Anesthesia and Chronic Pain Applications
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Interscalene Brachial Plexus
Nerve Block Indications
Shoulder Surgery,
Brachial Neuritis,
Shoulder Pain,
Frozen shoulder
Interscalene Region
Provides Anesthesia of the:
Shoulder,
Lateral clavicle,
Acromioclavicular joint,
Proximal humerus,
Elbow,
Brachial Plexus Anatomy
The Interscalene Brachial Plexus is ideal for analgesia of the shoulder and upper extremity. Due to its location, it will not reliably anesthetize the ulna nerve as the C8 to T1 nerve roots have yet to join the plexus at this access point.
Indications for Block
- Shoulder Surgery
- Brachial Neuritis
- Shoulder Pain
- Frozen shoulder
For Board Prep Check out:
Considerations
Locating the Brachial Plexus (described in video)
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Start in the anterior midline at the level of the thyroid gland and move laterally, identifying the carotid, internal jugular and then the anterior scalene and middle scalene, triangulating against the sternocleidomastoid muscle in the scan
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Alternatively you can start from the supraclavicular space and run the probe upwards
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A good place to end your search is where the nerves are lined up vertically (perpendicular to the probe) and the most lateral trunk (the superior trunk) is at it's most superficial position. “low” interscalene or “high” supraclavicular position from an external perspective
Complications
Often related to proximity of interscalene nerves to the:
vertebral artery,
the dome of the pleura,
the dura covering the cervical spinal cord,
the cervical spinal cord,
carotid artery,
internal jugular vein,
phrenic nerve leading to hemidiaphragmantic paralysis
Interscalene Brachial Plexus Dosing
Regional Anesthesia: 7-15ml of local anesthetic such as bucpivicaine 0.25%
Interventional Pain: 1-2 ml of local anesthetic with 2-4mg of dexamethasone per nerve
References
and Interesting Articles...
- RyungA Kang, Ji Seon Jeong, Ki Jinn Chin, Jae Chul Yoo, Jong Hwan Lee, Soo Joo Choi, Mi Sook Gwak, Tae Soo Hahm, Justin Sangwook Ko; Superior Trunk Block Provides Noninferior Analgesia Compared with Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery. Anesthesiology 2019; 131:1316–1326 doi: https://doi.org/10.1097/ALN.0000000000002919
- Paul G. McHardy, Oskar Singer, Imad T. Awad, Ben Safa, Patrick D.G. Henry, Alex Kiss, Shelly K. Au, Lilia Kaustov, Stephen Choi,Comparison of the effects of perineural or intravenous dexamethasone on low volume interscalene brachial plexus block: a randomised equivalence trial,British Journal of Anaesthesia,Volume 124,Issue 1,2020,Pages 84-91,ISSN 0007-0912,https://doi.org/10.1016/j.bja.2019.08.025.
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