Ambulatory continuous interscalene brachial plexus blockade

Abstract

Single-injection interscalene blocks provide excellent operating conditions, extended pain relief, and an advantageous side effect profile. As a result, anesthesiologists frequently perform them on an outpatient basis and are likely to discharge them insensate after using a long-acting local anesthetic. 1 However, a disadvantage to this practice is the regression of analgesia that often occurs after 12 to 24 hours when a single-injection technique is used. A significant portion of the pain relief and narcotic sparing is reduced when the block recedes rapidly after discharge. Depending on standard oral pharmacologic management for this transition is often insufficient to achieve the dense level of pain relief provided by the initial dose of local anesthetic. For shoulder surgery, this often results in severe pain. This is especially true for major shoulder surgery that typically requires a hospital stay for IV opioids. Ambulatory continuous interscalene brachial plexus block (CISB) can provide a solution for the rapid resolution of analgesia after a single injection block. This is especially true for major shoulder, clavicle, and humerus surgery. More importantly, CISB also provides continuous site-specific local anesthetic delivery, resulting in intense surgical anesthesia, effective long-term postoperative analgesia, reduced opioid requirements, an enhanced side effect profile, and may facilitate rehabilitation. Even relatively minor surgery, such as shoulder arthroscopy or rotator cuff repair, may benefit from this technique.