Author(s): ,
Billstrand, M.*
University of New Mexico, Anesthesiology and Critical Care, Albuquerque, USA
Vagh, F.
University of New Mexico, Anesthesiology and Critical Care, Albuquerque, USA
ESRA Academy. Billstrand M. Sep 13, 2017; 190884; 173 Topic: Peripheral Nerve Blocks
Mary Billstrand
Mary Billstrand

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Background and Aims:

In outpatient shoulder surgery we have noticed an increase in the BMI of patients.  Many of these patients may not tolerate a unilateral phrenic nerve paralysis.  Our goal of this project is to avoid phrenic nerve involvement that occurs with an interscalene block while also controlling pain.


We have developed two different methods for blocking patients for shoulder surgery with a BMI>30 and we compare these two approaches to determine which is easiest and provides the best pain relief without phrenic nerve compromise.  The first method is to place an anterior suprascapular1 block combined with a costoclavicular infraclavicular block 2 where the lateral and posterior cords are anesthetized. 
The second method places an axillary nerve block3,4combined with a posterior suprascapular5 block.  We have three patients in each group.
Posterior approach to axillary nerve


In the first method, two of the patients expressed pain relief of 2/10.  In both patients the suprascapular nerve was visualized under the omohyoid muscle and 2 ml of local were placed.   The third patient in the group required a rescue block for pain in the suprascapular nerve distribution. 

In the second method, in the first patient we couldn’t visualize either nerve to place the blocks.  In the second and third patients, the patients stated 5/10  and 4/10 pain scores in the PACU.Conclusions:

We have trialed two alternative ways to anesthetize the shoulder without phrenic nerve involvement.  We found the anterior suprascapular/infraclavicular approach to be the easiest to place while also providing the most consistent pain control.

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