Background: Despite a trend toward the use of regional anesthesia
for orthopaedic procedures, there has been resistance to the use of
interscalene regional block for shoulder surgery because of concerns about
failed blocks and potential complications.
Methods: We retrospectively reviewed the cases of 568 consecutive
patients who had shoulder surgery under interscalene regional block in a
tertiary-care, university-based practice with an anesthesiology residency
program. The blocks were performed by a group of anesthesiologists who were
dedicated to the concept of regional anesthesia in their practice. Complete
anesthetic and orthopaedic records were available for 547 patients. The
surgical procedure, planned type of anesthesia, occurrence of block failure,
and the presence of complications were noted.
Results: Of the 547 patients, 295 underwent an arthroscopic
procedure and 252 (including eighty who had an arthroplasty) underwent an open
procedure. General anesthesia was the initial planned choice for sixty-nine
patients because of the complexity or duration of the procedure, the anatomic
location, or patient insistence. Thirty-four of the sixty-nine patients also
received an interscalene regional block. Interscalene regional block alone was
planned for 478 patients. A total of 462 patients (97%) had a successful block
whereas sixteen required general anesthesia because the block was inadequate.
The success of the block was independent of the type or length of the surgery.
No patient had a seizure, pneumothorax, cardiac event, or other major
complication. Twelve (2.3%) of the 512 patients who had a block had minor
complications, which included sensory neuropathy in eleven patients and a
complex regional pain syndrome that resolved at three months in one patient.
For ten of the eleven patients, the neuropathy had resolved by six months.
Conclusions: Interscalene regional block provides effective
anesthesia for most types of shoulder surgery, including arthroplasty and
fracture fixation. When administered by an anesthesiologist committed to and
skilled in the technique, the block has an excellent rate of success and is
associated with a relatively low complication rate.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.