The lower concentration of the anaesthetic solution avoids complications while increased volume provides good analgesic cover. The combination of the Winnie interscalene plexus block and the Pippa proximal cranial needle approach should contribute to fill up the scalene sheath overcoming the septa obstacles.

Background and Goal of Study: Shoulder surgery is painful (1). Ambulatory surgery requires suitable anaesthetic techniques to accomplish high patient acceptance and optimal workflow (2). Interscalene plexus block (IPB) may be superior compared to general anaesthesia (TIVA) but may cause workflow delays. We compared the efficacy, postoperative pain, PACU performance and patient's satisfaction of IPB and TIVA for ambulatory arthroscopic shoulder surgery. Materials and Methods: After IRB approval and written informed consent 102 patients randomly allocated to IPB or TIVA were enrolled. IPB patients received ropivacaine 0,75% for the nerve block; TIVA patients were anaesthetised with propofol/alfentanil. Postoperative pain medication was standardized. We compared: (1) anaesthesia induction times, (2) time to discharge from PACU (modified Aldrete Score >12), (3) pain scores, (4) patients satisfaction. Statistics: student T test and x ² -test, p<0.05. Results and Discussion: Demographic data and duration of surgery were comparable. IPB was complete or satisfactory in all patients. Anaesthesia induction time and time to approval were comparable. A significant difference between groups was found in terms of time to PACU discharge ability ( fig. 1). Postoperative pain scores were significantly higher in the TIVA group ( fig. 2) without differences in patient satisfaction (IPB: 9,7±0,6 vs. TIVA: 9,7±0,5).

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