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, SRNA York College of Pennsylvania/ WellSpan Health Nurse Anesthesia Program Class of 2015

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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 - PowerPoint PPT Presentation

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Page 1: anesthesia for shoulder procedures: the Interscalene Brachial plexus block

ANESTHESIA FOR SHOULDER PROCEDURES: THE

INTERSCALENE BRACHIAL PLEXUS BLOCK

Shannon Bachman RN, BSN, SRNAYork College of Pennsylvania/ WellSpan Health Nurse Anesthesia ProgramClass of 2015

Page 2: anesthesia for shoulder procedures: the Interscalene Brachial plexus block

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

Page 3: anesthesia for shoulder procedures: the Interscalene Brachial plexus block

Alon P. Winnie

Page 4: anesthesia for shoulder procedures: the Interscalene Brachial plexus block
Page 5: anesthesia for shoulder procedures: the Interscalene Brachial plexus block

Winnie Technique

Page 6: anesthesia for shoulder procedures: the Interscalene Brachial plexus block

ISB vs. GA: The Data

I’m so happy!!!!

Argg blahhh…

Page 7: anesthesia for shoulder procedures: the Interscalene Brachial plexus block

ISB vs. GA: The Data

“…with 30% of patients reporting severe pain on the first postoperative day… [may result

in] unplanned overnight admission…”

Page 8: anesthesia for shoulder procedures: the Interscalene Brachial plexus block

ISB: PNS vs. Ultrasound guided

Page 9: anesthesia for shoulder procedures: the Interscalene Brachial plexus block

Phrenic Nerve

Page 10: anesthesia for shoulder procedures: the Interscalene Brachial plexus block

Volume

Page 11: anesthesia for shoulder procedures: the Interscalene Brachial plexus block

Volume cont.

Page 12: anesthesia for shoulder procedures: the Interscalene Brachial plexus block

Adverse Events #1. Mid Scalene#2. Ant Scalene#5. Phrenic Nerve#6.Brachial Plexus1

2

56

Page 13: anesthesia for shoulder procedures: the Interscalene Brachial plexus block

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

Page 14: anesthesia for shoulder procedures: the Interscalene Brachial plexus block

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.