ANESTHESIA FOR SHOULDER PROCEDURES: THE INTERSCALENE BRACHIAL PLEXUS BLOCK Shannon Bachman RN, BSN, SRNA York College of Pennsylvania/ WellSpan Health.

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Presentation transcript:

ANESTHESIA FOR SHOULDER PROCEDURES: THE INTERSCALENE BRACHIAL PLEXUS BLOCK Shannon Bachman RN, BSN, SRNA York College of Pennsylvania/ WellSpan Health Nurse Anesthesia Program Class of 2015

Objectives  Brief nod to Alon P. Winnie  Interscalene Brachial Plexus Block vs. General Anesthesia  Ultrasound Guided vs. PNS Technique  Local Anesthetic Volumes  Adverse Events  Case Study: Interscalene Catheter

Alon P. Winnie

Winnie Technique

ISB vs. GA: The Data I’m so happy!!!! Argg blahhh…

ISB vs. GA: The Data

ISB: PNS vs. Ultrasound guided

Phrenic Nerve

Volume

Volume cont.

Adverse Events #1. Mid Scalene #2. Ant Scalene #5. Phrenic Nerve #6.Brachial Plexus

Case report: “…different and sometimes devastating complications have been reported relating to either needle or catheter insertion or to the administration of local anaesthetic.”

References : Danelli, G., Bonarelli, S., Tognu, A., Ghisi, D., Fanelli, A., Biondini, S.,...Fanelli, G. (2012). Prospective randomized comparison of ultrasound-guided and neurostimulation techniques for continious interscalene brachial plexus block in patients undergoing coracoacromial ligament repair. British Journal of Anaesthesia, 108(6), Gonano, C., Kettner, S. C., Ernstbrunner, M., Schebesta, K., Chiari, A., & Marhofer, P. (2009). Comparison of economical aspects of interscalene brachial plexus blockade and general anaesthesia for arthroscopic shoulder surgery. British Journal of Anaesthesia, 103(3), Hadzic, A., Williams, B. A., Karaca, P. E., Hobeika, P., Unis, G., Dermksian, J.,...Santos, A. C. (2005). For outpatient rotator cuff surgery, nerve block anesthesia provides surerior same-day recovery ver general anesthesia. Pain and Regional Anesthesia, 102, Jeng, C. L., Torrillo, T. M., & Rosenblatt, M. A. (2010). Complications of peripheral nerve blocks. British Journal of Anaesthesia, 105(51), Liu, S. S., YaDeau, J. T., Shaw, P. M., Wilfred, S., Shetty, T., & Gordon, M. (2011). Incidence of unintentional intraneural injection and postoperative neurological complications with ultrasound-guided interscalene and supraclavicular nerve blocks. Anaesthesia, 66, Manavi, M. (2010). Lipid infusion as a treatment for local anesthetic toxicity: A literature review. AANA Journal, 78(1), McNaught, A., Shastri, U., Carmichael, N., Awad, I. T., Columb, M., Cheung, J.,...McCartney, C. J. (2010). Ultrasound reduces the minimum effective local anaesthetic volume compared with peripheral nerve stimulation for interscalene block. British Journal of Anaesthesia, 106(1), Ptaszynski, A. E., Horlocker, T. T., Bacon, D. R., & Rowlingson, J. C. (2006). Alon P. Wimmie, L. Donald Bridenbaugh, Jk., Harold Carron, P. Prithvi Raj, and Jordan Katz: Founding fathers of the American Society of Regional Anesthesia. Regional Anesthesia and Pain Medicine, 31(1), Riazi, S., Carmichael, N., Awad, I., Holtby, R. M., & McCartney, C. J. (2008). Effect of local anaesthetic volume (20vs 5ml) on the efficacy and respiratory consequences of ultrasound-guided interscalene brachial plexus block. British Journal of Anaesthesia, 101(4), Verela, H., & Burns, S. M. (2010). Use of lipid emulsions for treatment of local anesthetic toxicity: A case report. American Association of Nurse Anesthetists, 78(5), Winnie, A. P. (1970). Interscalene Brachial Plexus Block. Anesthesia and Analgesia, 49(3), Yanovski, B., Gaitni, L., Volodarski, D., & Ben-David, B. (2012). Catastrophic complication of an interscalene catheter for continious peripheral nerve block analgesia. Anaesthesia, 67, Yauger, Y. J., Bryngelson, J. A., Donohue, K., Lawhorn, L. A., Pitcher, B. M., Schoneboom, B. M., & Watts, D. D. (2010). Patient outcomes comparing CRNA-admnistered peripheral nerve blocks and general anesthesia: A retrospective chart revew in a US Army same-day surgery center. American Association of Nurse Anesthesia, 78(3),