Low interscalene block provides reliable anesthesia for surgery at or about the elbow

Abstract

Study Objective To determine whether interscalene brachial plexus block (ISB) provides adequate anesthesia for surgery on or about the elbow. Study Design Case series. Setting Operating room of an academic teaching hospital. Patients 78 patients scheduled for elective elbow surgery. Interventions All patients received an ISB using a low approach technique. A stimulating needle was inserted in the interscalene groove two cm above the clavicle. A volume of 35-45 mL of mepivacaine 1.5% or ropivacaine 0.5% was administered after obtaining a motor response of any component of the brachial plexus with a current intensity of 0.2-0.4 mA (0.1 msec). Measurements Block success rate, defined as the ability to complete surgery without use of intraoperative opioids or general anesthesia, was assessed. Verbal rating scores for pain (0 = no pain, 10 = worst pain imaginable) were obtained in the recovery room. Main Results Low ISB resulted in successful surgical anesthesia in 75 (96%) of the study patients. Verbal rating scores were low (0-2) for all patients postoperatively. Conclusions The low interscalene block can be used to provide surgical anesthesia in the majority of patients having surgery on or about the elbow.