Interscalene Block

Frequently Asked Question about an Interscalene Block

What is an interscalene block?

In surgeries of the upper arm and shoulder may use an Interscalene block which uses general anesthesia and a regional anesthesia. It will numb the patient’s arm and soldier before a surgery so that the nerves won’t send signals to the brain expressing the pain.

Who should get this procedure?

Patients who need to undergo a surgery in the upper arm or shoulder. It will be effective in reducing the pain that a patient may experience during or after the procedure. Not all patients will be able to use this type of anesthesia. You should consult your physician to see if this is the right procedure for you.

What are the benefits of having this procedure done?

The interscalene block will numb the area before the surgery. The patient will not feel the effects because the nerves are numb and therefore, will not be able to send signals to the brain. It will lower the level of pain that you feel that you normally feel during and after the surgery. It can also be a beneficial procedure because it will lower the amount of general anesthesia that is needed for the procedure because the area will already be numb. This can lower complications caused by the use of a general anesthetic. There have been many studies that have shown people who have the interscalene block done will experience a decreased amount of pain days after the surgery.

Are you put completely under for this procedure?

Most patients are put under light sedation for the surgery and will be awake. Patients are asked to position their body in a specific way which is needed to perform the surgery effectively and that is why they are not put completely under. Most patients will receive some pain medication and a sedative intravenously before they have the procedure. Some patients will receive supplemental oxygen that is delivered through the nose during the procedure.

Does it hurt?

The patients that are able to remember the procedure, have found that the IV catheter placement was more uncomfortable than the actual procedure.

How is the procedure performed?

The patient will be given an intravenous catheter to administer fluid and medication. The next step is where you will be administered sedation. The patient will lie flat on the back and will be looking away from the side where the injection will be. The anatomy will be drawn out with a skin marker.

They will outline the trachea, clavicle, and scalene muscles. They will then use a needle attached to a nerve stimulator to properly locate the brachial plexus which is between the two scalene muscles. Tubing is attached to the needle so that it can administer the medication. The nerve stimulator will cause the muscle to involuntarily move when it approaches the brachial plexus. This “twitching movement” will occur every couple seconds. When the needle is properly placed, the numbing medication is delivered until the “twitching movement” stops. The needle is then removed.

References:

Bharti, N., Bhardawaj, N., & Wig, J. (2015). Comparison of ultrasound-guided supraclavicular, infraclavicular and below-C6 interscalene brachial plexus block for upper limb surgery: a randomised, observer-blinded study. Anaesthesia & Intensive Care, 43(4), 468-472.

Jadon, A., Dixit, S., Kedia, S. K., Chakraborty, S., Agrawal, A., & Sinha, N. (2015). Interscalene brachial plexus block for shoulder arthroscopic surgery: Prospective randomised controlled study of effects of 0.5% ropivacaine and 0.5% ropivacaine with dexamethasone. Indian Journal of Anaesthesia, 59(3), 171-176. doi:10.4103/0019-5049.153039