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

Abstract

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.

Postoperative pain control for shoulder arthroplasty

“…with dexamethasone adjuvant had a significant decrease in antiemetic use and no significant differences in patient satisfaction [44]. The article by Kamineni and Cheppalli [45] describes significant pain control, by placing local anesthetic, in liquid and slow release forms, under direct visualization around the brachial plexus, using the same surgical approach as the open shoulder surgery. In this approach the senior author describes a satisfactory outcome rate of 96% of the more than 200 patients who underwent brachial plexus block for shoulder arthroplasty over 5 years [45].…”