A retrospective review of shoulder procedures using scalene block
anesthesia was performed.
The records of all 218 patients who had undergone scalene block
anesthesia over a three-year period at two facilities were retrospectively
reviewed. All blocks were performed with use of a standard blunt-needle
technique with the patient awake and with use of preoperative nerve
stimulation to localize the brachial plexus.
Adjunctive general anesthesia was used for 179 (82%) of the 218
patients. Seventy-two patients (33%) required intravenous pain medication
immediately on arrival in the recovery room, and twenty-eight blocks
(13%) failed. One grand mal seizure, one episode of cardiovascular
collapse, and four episodes of severe respiratory distress were
noted. Two patients had temporary neurologic injuries that persisted
at six weeks. The mean duration of the block was 9 ±
4.6 hours. Two hundred (92%) of the 218 patients required parenteral narcotics
despite the use of scalene block anesthesia.
Informed consent discussions regarding scalene block anesthesia
should include information on the prevalence of complications and
the efficacy of the technique.