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SHOULDER SURGERY: FROM INTERSCALENE BLOCK TO … ?
ESRA Academy. Van Herreweghe I. Sep 8, 2016; 138615
Topic: Shoulder Surgery
Imre Van Herreweghe
Imre Van Herreweghe

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Abstract
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Background and Aims:

Regional anesthesia is an excellent choice for post-operative analgesia in shoulder surgery since it is a very painful procedure. Three different techniques have been described to provide postoperative pain relief after shoulder surgery. Interscalene brachial plexus block (ISB) has been the golden standard for years. Recently supraclavicular brachial plexus block (SCB) and suprascapular nerve block in combination with an axillary brachial plexus block (SSN+AX) are gaining interest.

Methods:

A literature research was performed in May 2016 using PubMed, MEDLINE, and Cochrane databases. Non-English literature was excluded.

Results:

ISB is presumed to be more cost effective than general anesthesia alone and provides excellent postoperative analgesia. ISB however is associated with the highest incidence of permanent neurological complications of all peripheral nerve blocks. Other complications are pneumothorax and phrenic nerve paralysis. 

In the 21st century, US guided SCB became a good alternative for elective shoulder surgery.  US guidance reduces the incidence of pneumothorax. Low dose SCB has a lower incidence of hemidiaphragmatic paresis and hoarseness.

SSN + AX blocks the majority of the innervation of the shoulder joint and is described for peri- and postoperative analgesia. It resembles the anesthesia provided by the ISB, nevertheless residual pain is still to be expected since not all terminal nerve ends are blocked. 

Conclusions:

Ultrasound-guided PNB made it possible to reduce complications and reorganise the landscape of locoregional anesthesia of the upper limb. However, more prospective randomized controlled trials are necessary to objectively compare locoregional anesthesia techniques and their outcomes.

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