49 - Brachial Plexus Block: Interscalene Approach

Abstract

The interscalene approach to the brachial plexus is the preferred technique for brachial plexus block when anesthesia or relaxation of the shoulder is required. In addition to having applications for surgical anesthesia, interscalene brachial plexus nerve block with local anesthetic can be used as a diagnostic tool when differential neural blockade is performed on an anatomic basis for the evaluation of shoulder and upper extremity pain. If destruction of the brachial plexus is being considered, this technique can be used in a prognostic manner to indicate the degree of motor and sensory impairment that the patient may experience. Interscalene brachial plexus nerve block with local anesthetic may be used for palliation in acute pain emergencies, including acute herpes zoster, brachial plexus neuritis, shoulder and upper extremity trauma, and cancer pain, during the wait for pharmacologic, surgical, and antiblastic methods to take effect. Interscalene brachial plexus nerve block is also useful as an alternative to stellate ganglion block for treatment of reflex sympathetic dystrophy of the shoulder and upper extremity.