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Interscalene Brachial Plexus Block for Shoulder Surgery: A Proximal Paresthesia Is Effective

Roch James J. MD; Sharrock, Nigel E. MB, ChB; Neudachin, Ludmilla MB
Anesthesia & Analgesia: September 1992

This study was designed to determine whether the location of paresthesias is related to the success of interscalene blocks in providing anesthesia for shoulder surgery. Interscalene blocks were performed in 45 patients presenting for elective shoulder surgery. Interscalene injections of 33–55 mL of 1.5% mepiv-acaine with epinephrine were performed after the first elicited paresthesia to the shoulder, arm, forearm, or hand. In 20 patients (45%), the initial elicited paresthesia was to the shoulder, whereas in 25 patients (55%), the first parethesia was reported as distal to the shoulder. All patients developed brachial plexus anesthesia adequate for shoulder surgery. The time-course of onset of motor block as evaluated at the shoulder and elbow was not different between patients with shoulder paresthesias and those with more distal paresthesias. Handgrip strength was quantitatively evaluated with a dynamometer, and both paresthesia groups showed similar decrements in hand strength except at the end of the measurement period, when patients with distal paresthesias had a significantly weaker handgrip than patients with shoulder paresthesias. We recommend that paresthesias to the shoulder be accepted in performing interscalene blocks for patients undergoing shoulder surgery.

Address correspondence to Dr. Roch, Department of Anesthesiology, The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021.

© 1992 International Anesthesia Research Society