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The first brachial plexus blocks were performed by Halsted, in 1885, at the Roosevelt Hospital in New York City. Later Crile, in 1902, described an “open approach” to expose the plexus to the direct application of cocaine. At the time, however, the clinical applicability of this approach was limited because of the need for surgical exposure of the brachial plexus. Percutaneous access to the brachial plexus was described in the early 1900s. In 1925, Etienne1 reported the successful blockade of the brachial plexus by inserting a needle at the level of the cricothyroid membrane, halfway between the lateral border of the sternocleidomastoid and the anterior border of the trapezius muscle after a single injection through the area around the scalene muscles. This approach is most likely the first clinically useful interscalene block technique.


Different approaches were then tried until Winnie, in 1970,2 described the percutaneous technique of injecting local anesthetic into the groove between the anterior and middle scalene muscles at the level of the cricoid cartilage. This approach was the first consistently effective and technically suitable technique, and it allowed wider applicability of interscalene brachial plexus block. Winnie's approach was further modified, in line with numerous developments in regional anesthesia, by the placement of a perineural catheter, for example.3




Interscalene block is well suited for surgical procedures involving the shoulder, including the lateral two thirds of the clavicle, proximal humerus, and shoulder joint. Interscalene block can be used in the setting of arm or forearm surgery, but incomplete blockade of the inferior trunk often results in insufficient analgesia in the ulnar distribution. The patient's positioning and comfort, the surgeon's preferences, and the duration of surgery sometimes necessitate a combined general anesthesia. The indications for single-shot and interscalene catheter are summarized in Table 25–1.

Table Graphic Jump Location
Table 25-1. Single-Injection vs. The Choice of Technique: Interscalene Catheter According to Surgery. 
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Clinical Pearls
  • Adequate control of pain is crucial after major open-shoulder surgery; early rehabilitation is necessary for improving success.
  • A major characteristic of the pain after shoulder surgery is its dynamic component, which often interferes with rehabilitation.
  • Up to 70% of patients report severe pain on movement after ...

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