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
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. Single-Injection vs. The Choice of Technique: Interscalene Catheter According to Surgery. |Favorite Table|Download (.pdf)
Table 25-1. Single-Injection vs. The Choice of Technique: Interscalene Catheter According to Surgery.
|Type of Surgery||Type of Block Single-Injection||Catheter|
|Rotator cuff repair||+||+|
|Proximal humerus osteosynthesis||+||±|
|Clavicle osteosynthesis cervical block)||+ (± superficial cervical block)||–|
|Rotator cuff repair||+||+|
- 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 open ...