Thread by @amit_pawa

My last #ECONGRESS2020 #ESRAASRA2020 session for the day!

Shoulder surgery hurts!

Interscalene block is currently the gold standard

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Check out these Prospect Guidelines

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…-publications.onlinelibrary.wiley.com/doi/full/10.11…

Most people start from supraclavicular fossa and then slide the probe up the neck.

Key is to identify the Cervical Transverse Processes to identify Nerve roots.

Also identify phrenic if possible

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One of the potential advantages of the out-of-plane interscalene block is avoidance of the dorsal scapular nerve within Middle Scalene Muscle.
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My anxiety is always inadvertent Vertebral artery injection and needle tip visualisation

Make sure you do your shoulder block before the Suprascapular Nerve has left the superior trunk.

This is why traditionally supraclavicular brachial plexus block was not recommended for shoulder surgery

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Biggest complaint I have had from pts having shoulder surgery with blocks is duration of analgesia Vs Heaviness!
I use superior trunk block with 7-11 cc’s of LA, and couple of cc’s to Supraclavicular nerves.
Usually spares hand.
How about u guys?
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Is there a role for:

Short acting block with local infiltration?

Or

Pre-emptive strong opioids to prevent rebound pain? 🙉

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Is it ok to perform an interscalene block at the end of the procedure to maximise duration?

Panel suggest doing awake, before induction of anaesthesia.

Is this what all practitioners do anyway?

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Do you perform Interscalene block...

Now @docmorne talking on Axillary & Suprascapular nerve blocks #ECONGRESS2020 #ESRAASRA2020

Don’t forget the ligaments and Bursae, plus multiple muscles, bones and joints!

The shoulder is complex!

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Using SSN & AxN block is associated with high success rate and zero incidence of phrenic nerve paresis in this study...

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The Axillary nerve in green here.

Is blocking it on the proximal humerus too distal for shoulder?

What about posterior cord injection?

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Another reference to @DrPhilipPeng ‘s work rapm.bmj.com/content/44/4/4…

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When looking for suprascapular nerve in supraclavicular fossa, identity Omohyoid...

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These studies are comparing anterior and posterior approach to suprascapular nerve.

Is the poster approach failure attributed to a misidentified suprascapular block?

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Anyone tried this?

Anterior approach to the axillary nerve?

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Interesting!

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@docmorne will often add a PEC1 (interpectoral injection) for shoulder arthroplasty to get the lateral pectoral nerve!

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Summary Slide - phrenic nerve sparing options #ECONGRESS2020 #ESRAASRA2020