No. 30 1. Cervical Plexus 1. Cervical Plexus 2. Brachial Plexus 2. Brachial Plexus.
anesthesia for shoulder procedures: the Interscalene Brachial plexus block
description
Transcript of anesthesia for shoulder procedures: the Interscalene Brachial plexus block
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ANESTHESIA FOR SHOULDER PROCEDURES: THE
INTERSCALENE BRACHIAL PLEXUS BLOCK
Shannon Bachman RN, BSN, SRNAYork College of Pennsylvania/ WellSpan Health Nurse Anesthesia ProgramClass of 2015
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ObjectivesBrief nod to Alon P.
Winnie Interscalene Brachial
Plexus Block vs. General Anesthesia
Ultrasound Guided vs. PNS Technique
Local Anesthetic Volumes
Adverse EventsCase Study:
Interscalene Catheter
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Alon P. Winnie
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Winnie Technique
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ISB vs. GA: The Data
I’m so happy!!!!
Argg blahhh…
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ISB vs. GA: The Data
“…with 30% of patients reporting severe pain on the first postoperative day… [may result
in] unplanned overnight admission…”
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ISB: PNS vs. Ultrasound guided
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Phrenic Nerve
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Volume
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Volume cont.
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Adverse Events #1. Mid Scalene#2. Ant Scalene#5. Phrenic Nerve#6.Brachial Plexus1
2
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Case report: “…different and sometimes devastating complications have been reported relating to either needle or catheter insertion or to the administration of local anaesthetic.”
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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), 1006-1010.
• 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), 428-433.
• 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, 1001-1007.
• Jeng, C. L., Torrillo, T. M., & Rosenblatt, M. A. (2010). Complications of peripheral nerve blocks. British Journal of Anaesthesia, 105(51), 97-107.
• 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, 168-174.
• Manavi, M. (2010). Lipid infusion as a treatment for local anesthetic toxicity: A literature review. AANA Journal, 78(1), 69- 78.• 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), 124-130.
• 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), 71-78.
• 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), 549-556.
• 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), 359-364.
• Winnie, A. P. (1970). Interscalene Brachial Plexus Block. Anesthesia and Analgesia, 49(3), 455-466. • Yanovski, B., Gaitni, L., Volodarski, D., & Ben-David, B. (2012). Catastrophic complication of an interscalene catheter for
continious peripheral nerve block analgesia. Anaesthesia, 67, 1166-1169. • 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), 215-220.