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Ultrasound-Guided Interscalene Block Anesthesia for Shoulder ArthroscopyA Prospective Study of 1319 Patients
Anshu Singh, MD1; Charles Kelly, MD2; Travis O’Brien, BS2; Jeffrey Wilson, MD2; Jon J.P. Warner, MD2
1 5893 Copley Drive, San Diego, CA 92111. E-mail address: anshu_singh@hotmail.com
2 Department of Anesthesia (C.K. and J.W.) and The Harvard Shoulder Service (T.O’B. and J.J.P.W.), Massachusetts General Hospital, 55 Fruit Street, YAW 3G, Boston, MA 02114. E-mail address for J.J.P. Warner: jpwarner@partners.org
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Investigation performed at the Orthopaedic Ambulatory Surgery Center at Mass General West, Waltham, Massachusetts

A commentary by Ashley Shilling, MD, is linked to the online version of this article at jbjs.org.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Nov 21;94(22):2040-2046. doi: 10.2106/JBJS.K.01418
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Ultrasound guidance improves the localization of anesthetic placement during regional anesthesia, but a decreased rate of adverse events has not been demonstrated in the current literature. In this large prospective study, we evaluated the safety, efficacy, and patient satisfaction associated with ultrasound-guided interscalene block.


A cohort of 1319 patients undergoing arthroscopic shoulder surgery at an outpatient surgery center was prospectively evaluated. Interscalene blocks were performed by experienced anesthesiologists and trainees with use of ultrasound guidance. Patients were queried by a physician twenty-four hours postoperatively regarding their satisfaction with the interscalene block and were screened for a comprehensive register of minor and major adverse events. Individuals with adverse events were followed until symptoms resolved.


Interscalene block was ultimately successful in 99.6% of the cases. A total of thirty-eight adverse events (prevalence, 2.88%) were noted. At the time of the latest follow-up, permanent sequelae were present in three patients (0.23%), all of whom had relevant comorbidities. With regard to patient satisfaction, 99.06% of the respondents were “satisfied” or “very satisfied” with the interscalene block, whereas 0.94% of respondents were unsatisfied. In addition, 97.8% of the patients stated that they would elect to have an interscalene block again in the future.


The present study supports the use of ultrasound-guided interscalene block by trained anesthesiologists for well-screened patients undergoing shoulder arthroscopy, given the high rate of patient satisfaction and the low rate of adverse events.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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