Korean J Pain.  2016 Jan;29(1):18-22. 10.3344/kjp.2016.29.1.18.

Ultrasound Guided Low Approach Interscalene Brachial Plexus Block for Upper Limb Surgery

• Park SK
• Sung MH
• Suh HJ
• Choi YS

• KMID: 2151655
• DOI: http://doi.org/10.3344/kjp.2016.29.1.18

Abstract

BACKGROUND
The interscalene brachial plexus block is widely used for pain control and anesthetic purposes during shoulder arthroscopic surgeries and surgeries of the upper extremities. However, it is known that interscalene brachial plexus block is not appropriate for upper limb surgeries because it does not affect the lower trunk (C8-T1, ulnar nerve) of the brachial plexus.
METHODS
A low approach, ultrasound-guided interscalene brachial plexus block (LISB) was performed on twenty-eight patients undergoing surgery of the upper extremities. The patients were assessed five minutes and fifteen minutes after the block for the degree of block in each nerve and muscle as well as for any complications.
RESULTS
At five minutes and fifteen minutes after the performance of the block, the degree of the block in the ulnar nerve was found to be 2.8 +/- 2.6 and 1.1 +/- 1.8, respectively, based on a ten-point scale. Motor block occurred in the median nerve after fifteen minutes in 26 of the 28 patients (92.8%), and in all of the other three nerves in all 28 patients. None of the patients received additional analgesics, and none experienced complications.
CONCLUSIONS
The present study confirmed the achievement of an appropriate sensory and motor block in the upper extremities, including the ulnar nerve, fifteen minutes after LISB, with no complications.

Keyword

Complication; Interscalene brachial plexus block; Nerve stimulator; Sensory block; Ultrasound-guided; Upper limb surgery

MeSH Terms

Analgesics
Arthroscopy
Brachial Plexus*
Humans
Median Nerve
Shoulder
Ulnar Nerve
Ultrasonography*
Upper Extremity*
Analgesics

Figure

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  Fig. 1 Anatomical landmark (A) and ultrasound probe and block needle position during ultrasound-guided low approach interscalene brachial plexus block (B).

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  Fig. 2 Ultrasound image showing low approach interscalene brachial plexus block. Needle pathway (arrows), SCM: sternocleidomastoid muscle, IJV: internal jugular vein, ST: superior trunk of brachial plexus, MSM: middle scalene muscle.

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