A retrospective analysis of neurological complications after ultrasound guided interscalene block for arthroscopic shoulder surgery

Jeong, Ji Sun; Kim, Youn Jin; Woo, Jae-Hee; Kim, Chi Hyo; Chae, Ji Seon

doi:10.17085/apm.2018.13.2.184

Cited by 3 publications

(2 citation statements)

References 30 publications

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“…[5][6][7][8][9] Some of the most common complications associated with ISNBs include paralysis of the hemidiaphragm (due to the blockade of the phrenic nerve), sudden rebound pain during or after postoperative day 1, chronic and/or persistent neurologic complications, serious respiratory (pneumothorax) and cardiovascular events. [9][10][11][12] Despite ultrasound guidance reducing the risk of intravascular and intraneural injection, these complications continue to be reported in the literature. 11,13 The cost analysis of ISBs includes consumables (anesthetic drugs, drapes, and site preparation) personnel costs (requiring trained staff to perform time out and inject and trained anesthesiologist to perform the procedure) equipment costs (ultrasound or nerve catheter), establishment costs (well-equipped procedure room according to the hospital guidelines) and time required to wait for the block to take effect.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12] Despite ultrasound guidance reducing the risk of intravascular and intraneural injection, these complications continue to be reported in the literature. 11,13 The cost analysis of ISBs includes consumables (anesthetic drugs, drapes, and site preparation) personnel costs (requiring trained staff to perform time out and inject and trained anesthesiologist to perform the procedure) equipment costs (ultrasound or nerve catheter), establishment costs (well-equipped procedure room according to the hospital guidelines) and time required to wait for the block to take effect. If the block is performed in the operating room, this could decrease the efficiency of the surgical schedule.…”

Section: Discussionmentioning

confidence: 99%

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Surgeon-administered intraoperative brachial plexus block for open shoulder surgery - a novel and safe technique

Kamineni

Cheppalli

2022

Shoulder & Elbow

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In the era of outpatient shoulder surgery, bundled payment, safe, predictable, and time-efficient pain management strategies for shoulder arthroplasty (SA) are important. Ultrasound-guided interscalene blocks (ISBs), currently the gold standard for postoperative pain management after shoulder surgery, can be highly operator dependent, time-consuming, and not without complications. We developed a new surgical technique of surgeon-administered intraoperative brachial plexus block in patients undergoing SA open shoulder surgery using the deltopectoral approach. This procedure could be performed after the exposure, either at the beginning or end of the bony work. This procedure is simple, safe, and effective. We did not notice any complications that are typically seen with ISB-like respiratory depression secondary to phrenic nerve palsy, rebound pain after the block wore off, and pain related conversion of outpatient SA to inpatient, over the period of four years (2018–2022). This technique has additional advantages over the established “gold standard” ISB in terms of time and cost savings and improved operating room efficiency.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgeon-administered intraoperative brachial plexus block for open shoulder surgery - a novel and safe technique

Kamineni

Cheppalli

2022

Shoulder & Elbow

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Postoperative neurologic symptoms in the operative arm after shoulder surgery with interscalene blockade: a systematic review

Mutter

Logan

Neily

et al. 2022

Can J Anesth/J Can Anesth

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Inadvertent Brachial Plexus Injury after Ultrasound-guided Interscalene Nerve Block: Diagnosis and Recovery

Pushpasekaran¹,

Oppilamani²,

Kandasamy³

2023

Journal of Orthopedics and Joint Surgery

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Background: Brachial plexus injury subsequent to an interscalene block (ISB) can be a difficult situation. Ultrasound-guided interscalene block (US-ISB) is currently the preferred technique; however, there is conflicting evidence in the existing literature about the elimination of this uncommon complication. Less is known about the nature and severity of the resulting neurological sequel as only few case studies are available in literature. Case description: A 28-year-old male underwent an elective removal of the dynamic compression plate and screws in a united fracture of humerus for constant pain with day-to-day activities. An ISB was performed under ultrasound guidance without any remarkable events during the procedure. Untowardly, the patient had experienced complete motor and sensory inactivity around shoulder and elbow in the postoperative period that persisted even at 3 weeks. Magnetic resonance imaging showed evidences of brachial plexus injury involving C5 and C6 roots extending to trunks. A conservative approach with rehabilitation and electrical muscle stimulation (EMS) was followed. Gradual recovery was observed and by 7 months he attained power to preinjury level. Conclusion:The practice of ISBs for upper limb surgeries does exhibit a rare risk of severe neuronal injury, even with established safe practices using ultrasound guidance. There are inconsistent evidences in the literature regarding permanent damage to brachial plexus following US-ISB and the resulting plexopathy shows complete recovery with conservative management. Clinical significance: Ultrasound guidance for ISBs may not be totally immune to neurological injury; however, the magnitude is of lesser severity and spontaneous recovery should be the rule.

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A retrospective analysis of neurological complications after ultrasound guided interscalene block for arthroscopic shoulder surgery

Cited by 3 publications

References 30 publications

Surgeon-administered intraoperative brachial plexus block for open shoulder surgery - a novel and safe technique

Surgeon-administered intraoperative brachial plexus block for open shoulder surgery - a novel and safe technique

Postoperative neurologic symptoms in the operative arm after shoulder surgery with interscalene blockade: a systematic review

Inadvertent Brachial Plexus Injury after Ultrasound-guided Interscalene Nerve Block: Diagnosis and Recovery

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