Our Maverick Medical Education classes cover a number of different topics to provide pain relief or medical techniques suited to help you treat your patients in a more effective manner. As part of the training in some of our courses, different nerve blocks are taught, including the interscalene nerve block.
What is it?
Alon Winnie is credited with raising awareness and increasing the popularity of this block in 1970. By placing local anesthetic between the anterior and middle scalene muscles, near the roots of the brachial plexus, it is possible to perform medical procedures on the shoulder and upper arm. This technique is also helpful with treatment for a humerus or clavicle fracture, but is not recommended for surgical procedures involving the forearm or hand, due to the ulnar nerve distribution at C8-T1 being more appropriate. The brachial plexus supplies nerves to the clavicle, different muscles in the upper arm, upper chest, and shoulder, and into the first rib. There are some anatomical differences in some patients, so ultrasound can be beneficial in helping determine if this block will be most effective for the patient.
Why is it beneficial?
In general, the interscalene block is considered to be very safe. While it is possible that other nearby nerves could come in contact with the anesthesia during the procedure, causing additional numbing to take place, with careful administration this is less likely to occur. If it does, the effects would last the same duration in many cases. A few patients, 5-10%, may feel longer term effects, including an abnormal sensation at the injection site, but they usually disappear within a few weeks. Depending on the needs of the patient and the decisions of medical staff, using “ropivacaine 0.5%, bupivacaine 0.25–0.5%, and mepivacaine 1.5%” for the block can provide pain relief for 12-24 hours post surgery and using “bupivacaine liposome” for the block can provide pain relief for 48-72 hours allowing for rest and healing to take place.
How to perform:
Once decided upon, the patient should lie in a supine position, head facing away from the side where the operation is taking place. The area should be sterilized and a local anesthetic applied. If the block is going to be assisted by ultrasound, it can be helpful to elevate the shoulder a bit with a small towel or other soft object. General anesthesia or sedation can be used, but the patient should be monitored during the administration of the block. The interscalene groove will be identified, using a number of anatomical landmarks on the patient and through palpitation methods to make sure placement is correct. Nerve stimulation or ultrasound guided blocks are possible, or some combination of both.
To learn more about the techniques our Maverick instructors teach, check out our courses. We offer a number of courses to help you meet your community’s needs. For questions, contact us today.