Comparison of interscalene brachial plexus block and superior trunk block with ropivacaine in shoulder arthroscopic surgery / 药学实践杂志

Objective To compare the clinical effects of interscalene brachial plexus block and superior trunk block in arthroscopic shoulder surgery with 0.25% ropivacaine. Methods 46 patients undergoing shoulder arthroscopy surgery were included and randomly divided into group ISB (n=23) and group ST (n=23). Patients in group ISB received 10 ml 0.25% ropivacaine on the lateral side of C5 and C6. Patients in group ST were treated with 5 ml 0.25% ropivacaine on both sides of the superior trunk of brachial plexus. The diaphragmatic excursion, Numerical Rating Scale(NRS), duration of the block, handgrip strength were recorded at different time. Results No statistical difference was detected between the two groups in the reduction of diaphragmatic excursion within 30 min after block (P>0.05). Compared with ISB patients, ST patients had significantly less diaphragmatic excursion at 3 h after block（P<0.05). 30 minutes after block, 8.7% patients in ISB group reached complete HDP and 52.2% patients reached partial HDP. At the same time, no complete HDP and 26.1% partial HDP were detected in ST group. 3 hours after block, patients in ST group had lower complete HDP rate (0.0% vs 17.4%) and lower partial HDP rate (39.1% vs 65.2%) than patients in ISB group. At 30 minutes and 3 h after block, the reduction of grip strength in ST group was significantly lower than that in ISB group (P<0.001). ST group had lower NRS than ISB group (P<0.05). The average block time in ISB group (8.3±1.97 )h was significantly lower than that in ST group (10.9±1.26)h (P<0.01). Conclusion Superior trunk block with 10 ml 0.25% ropivacaine is superior compared to interscalene brachial plexus block in occurrence of HDP, decrease of grip strength, postoperative pain and block duration.

Determination of ECs0 of ropivacaine for postoperative analgesia under general anesthesia combined with single interscalene brachial plexus block / 临床麻醉学杂志

Objective To determine the 50％ minimum effective concentration (EC50) of ropivacaine for postoperative analgesia after shoulder arthroscopy under general anesthesia combined with interscalene brachial plexus block.Methods Patients undergoing selective shoulder arthroscopy were included in this study.There were 9 males and 13 females,BMI 18-28 kg/m2,falling into ASA physical status Ⅰ or Ⅱ.The interscalene brachial plexus block was achieved under the guidance of ultrasound and nerve stimulator at the level of C6.The upper trunk of interscalene brachial plexus was blocked with 5 ml ropivacaine.The concentration of ropivacaine intially was 0.5 ％ and then depended on the response of the previous patient's postoperative NRS scale.The target ropivacaine concentration was determined by up and down sequential method.The ratio of two consecutive ropiva caine was 1.2.Two termination conditions were,firstly,to achieve seven negative-positive up-anddown deflections required to calculate EC50,and secondly,to deriminate if 7 were positive outcomes using 5 ml of 0.1 ％ ropivacaine or 7 were negative outcomes using 5 ml of 1 ％ ropivaciane.EC50 and 95％CI of ropivacaine was calculated using the formula of Dixon-Massey sequential method.The incidence of hemidiaphragmatic paresis was evaluated.Pre-and post-operative pulmonary function was compared using paired t test.Results The EC50 of ropivacaine was 0.21％ (95 ％CI 0.18％-0.25 ％).The incidence of hemidiaphragmatic paresis was 9 cases(40.90％).Postoperative FVC and FEV1/FVC was significantly decreased than preoperative,but FEV1 (P =0.116) was not.Conclusion For patients undergoing shoulder arthroscopy under general anesthesia and interscalene brachial plexus block,the minimum effective concentration of ropivacaine for analgesia of EC50 is 0.21％,95％ CI 0.18％-0.25％.

Application of ultrasound-guided selective cervical nerve root block for patients undergoing arthroscopic surgery in perioperative period / 临床麻醉学杂志

Objective To compare effectiveness,performance,and complications between ultrasound-guided selective cervical nerve root block and interscalene brachial plexus block for patients undergoing arthroscopic surgery in perioperative period.Methods Seventy patients scheduled for arthroscopic surgery,25 males and 45 females,aged 18-75 years,were randomly divided into two groups.They were given either selective cervical nerve root block (group S,n =35) or interscalene brachial plexus block (group ISB,n=35).In group S,C5 and C6 nerve roots were given 0.5％ ropivacaine 5 ml respectively;In group ISB,patients were given 0.5％ ropivacaine 10 ml under ultrasound guidance.The primary outcome:VAS score and forearm modified Bromage scale (MBS) score were recorded at 4,12 and 24 hours after surgery;Secondary outcomes:cumulative tramadol consumption,the patients' satisfaction rate and adverse effects were recorded.Results The VAS scores in group S was significantly lower than that in group ISB at 12 hours after surgery (1.7±0.8 vs 3.6±0.7,P＜0.05).The forearm MBS scores in group S was significantly higher than that in group ISB 4 hours after surgery (P＜0.01).Compared with group ISB,the amount of tramadol consumption was lower at 24 hours after surgery [(37.5±35.9) mg vs (112.5±43.5) mg,P＜0.05)].The satisfaction rate of group S was higher than group ISB (88％ vs 56％,P＜0.05).There was no significant difference in side effects between the two groups.Conclusion In arthroscopic surgery,the selective cervical nerve root block is superior to the brachial plexus block.

Aphonia after shoulder surgery: case report / Afonia após cirurgia do ombro: relato de caso

ABSTRACT In this case report we highlight the uniqueness of aphonia as, to the best of our knowledge, cases of aphonia related to interscalene brachial plexus block (IBPB) are not described in the literature. Although hoarseness is a common complication of IBPB, aphonia is not. Therefore, we think it is important to publicize the first case of aphonia after IBPB, which may have arisen only because of a recurrent laryngeal nerve chronic injury contralateral to the IBPB site.

RESUMO Relativamente a este relato de caso destacamos a sua singularidade, uma vez que não se encontram descritos na literatura, tanto ou quanto os autores puderam investigar, casos de afonia após uma anestesia combinada com bloqueio do plexo braquial via interescalénica (BPBI). Embora a rouquidão seja uma complicação frequente do BPBI, a afonia não o é. Desse modo, pensamos ser importante dar a conhecer o primeiro caso de afonia após o BPBI, que na opinião dos autores surgiu apenas por causa de uma lesão crônica do nervo laríngeo recorrente contralateral ao local do BPBI.

Risk of Encountering Dorsal Scapular and Long Thoracic Nerves during Ultrasound-guided Interscalene Brachial Plexus Block with Nerve Stimulator

BACKGROUND: Recently, ultrasound has been commonly used. Ultrasound-guided interscalene brachial plexus block (IBPB) by posterior approach is more commonly used because anterior approach has been reported to have the risk of phrenic nerve injury. However, posterior approach also has the risk of causing nerve injury because there are risks of encountering dorsal scapular nerve (DSN) and long thoracic nerve (LTN). Therefore, the aim of this study was to evaluate the risk of encountering DSN and LTN during ultrasound-guided IBPB by posterior approach. METHODS: A total of 70 patients who were scheduled for shoulder surgery were enrolled in this study. After deciding insertion site with ultrasound, awake ultrasound-guided IBPB with nerve stimulator by posterior approach was performed. Incidence of muscle twitches (rhomboids, levator scapulae, and serratus anterior muscles) and current intensity immediately before muscle twitches disappeared were recorded. RESULTS: Of the total 70 cases, DSN was encountered in 44 cases (62.8%) and LTN was encountered in 15 cases (21.4%). Both nerves were encountered in 10 cases (14.3%). Neither was encountered in 21 cases (30.4%). The average current measured immediately before the disappearance of muscle twitches was 0.44 mA and 0.50 mA at DSN and LTN, respectively. CONCLUSIONS: Physicians should be cautious on the risk of injury related to the anatomical structures of nerves, including DSN and LTN, during ultrasound-guided IBPB by posterior approach. Nerve stimulator could be another option for a safer intervention. Moreover, if there is a motor response, it is recommended to select another way to secure better safety.

Ultrasound Guided Low Approach Interscalene Brachial Plexus Block for Upper Limb Surgery

BACKGROUND: The interscalene brachial plexus block is widely used for pain control and anesthetic purposes during shoulder arthroscopic surgeries and surgeries of the upper extremities. However, it is known that interscalene brachial plexus block is not appropriate for upper limb surgeries because it does not affect the lower trunk (C8-T1, ulnar nerve) of the brachial plexus. METHODS: A low approach, ultrasound-guided interscalene brachial plexus block (LISB) was performed on twenty-eight patients undergoing surgery of the upper extremities. The patients were assessed five minutes and fifteen minutes after the block for the degree of block in each nerve and muscle as well as for any complications. RESULTS: At five minutes and fifteen minutes after the performance of the block, the degree of the block in the ulnar nerve was found to be 2.8 +/- 2.6 and 1.1 +/- 1.8, respectively, based on a ten-point scale. Motor block occurred in the median nerve after fifteen minutes in 26 of the 28 patients (92.8%), and in all of the other three nerves in all 28 patients. None of the patients received additional analgesics, and none experienced complications. CONCLUSIONS: The present study confirmed the achievement of an appropriate sensory and motor block in the upper extremities, including the ulnar nerve, fifteen minutes after LISB, with no complications.

Analgesia effect of magnesium sulfate in ultrasound-guided interscalene brachial plexus block in limb sur-gery / 临床麻醉学杂志

Objective To observe the anesthesia and analgesia effect of ultrasound guided inter-scalene brachial plexus block (ISPSP)on upper extremity surgery.Methods Fifty-four patients (male 34 cases,female 20 cases,aged 37-73 years,ASA grade Ⅰ or Ⅱ)scheduled for elective upper limb surgery under ISPBP combined with general anesthesia were randomly assigned into two groups:magnesium sulfate group (group M,n =27)and control group (group N,n =27).0.5% ropivacaine 8ml (40 mg)+10% magnesium sulfate 2 ml (0.5 g)were used in group M ,0.5% ropivacaine 8 ml+ normal saline 2ml (40 mg)were used in group N.After the effects of ISBPB were confirmed,pa-tients were inserted laryngeal mask under intravenous induction.Anesthesia was maintained by inha-ling sevoflurane(MAC 0.8)during the operation.The onset time of sensory and motor block,duration of sensory and motor block,duration of analgesia,pain visual analogue digital score (VAS)4,8,12, 24 hours after operationand complications were recorded.Results Duration of sensory block and du-ration of analgesia of group M was significantly longer than those of group N (P <0.05).The patient`s VAS score of 8,12,24 hours after surgery in group M was significantly lower than that on group N (P <0.05).Onset time of sensory and motory block of both groups was similar.Conclusion 0.5%ropivacaine combined with magnesium sulfate in ultrasound-guided ISPBP can extend the duration of sensory block,reduce postoperative pain,as well as prolong analgesia time.

Comparison of interscalene brachial plexus block and intra-articular local anesthetic administration on postoperative pain management in arthroscopic shoulder surgery / Comparação de bloqueio do plexo braquial por via interescalênica e administração de anestésico local intra-articular no manejo da dor no pós-operatório de cirurgia artroscópica do ombro / Comparación de bloqueo del plexo braquial por vía interescalénica y administración de anestésico local intraarticular en el manejo del dolor en el postoperatorio de cirugía artroscópica del hombro

BACKGROUND AND OBJECTIVES: In this study, the aim was to compare postoperative analgesia effects of the administration of ultrasound-guided interscalene brachial plexus block and intra-articular bupivacaine carried out with bupivacaine. METHODS: In the first group of patients 20 mL 0.25% bupivacaine and ultrasound-guided interscalene brachial plexus block (ISPB) were applied, while 20 mL 0.25% bupivacaine was given via intra-articular (IA) administration to the second group patients after surgery. Patients in the third group were considered the control group and no block was performed. Patient-controlled analgesia (PCA) with morphine was used in all three groups for postoperative analgesia. RESULTS: In the ISPB group, morphine consumption in the periods between 0-4, 6-12 and 12-24 postoperative hours and total consumption within 24 h was lower than in the other two groups. Morphine consumption in the IA group was lower than in the control group in the period from 0 to 6 h and the same was true for total morphine consumption in 24 h. Postoperative VASr scores in the ISPB group were lower than both of the other groups in the first 2 h and lower than the control group in the 4th and 6th hours (p < 0.05). In the IA group, VASr and VASm scores in the 2nd, 4th and 6th hours were lower than in the control group (p < 0.05). CONCLUSION: Interscalene brachial plexus block was found to be more effective than intra-articular local anesthetic injection for postoperative analgesia. .

JUSTIFICATIVA E OBJETIVOS: Comparar os efeitos na analgesia no pós-operatório da administração de bloqueio do plexo braquial por via interescalênica guiado por ultrassom e bupivacaína intra-articular, feito com bupivacaína. MÉTODOS: No primeiro grupo de pacientes, 20 mL de bupivacaína a 0,25% e bloqueio do plexo braquial por via interescalênica guiado por ultrassom (BPBI) foram administrados, enquanto 20 mL de bupivacaína a 0,25% foram administrados por via intra-articular (IA) ao segundo grupo de pacientes após a cirurgia. Os pacientes do terceiro grupo foram considerados grupo controle e nenhum bloqueio foi feito. Analgesia controlada pelo paciente (ACP) com morfina foi usada nos três grupos para analgesia pós-operatória. RESULTADOS: No grupo BPBI, o consumo de morfina nos períodos entre 0-4, 6-12 e 12-24 horas após a cirurgia e o consumo total em 24 horas foram mais baixos do que nos outros dois grupos. O consumo de morfina no grupo IA foi menor do que no grupo controle no período de 0-6 horas, como também foi menor o consumo total de morfina em 24 horas. Os escores EVAr no pós-operatório do grupo BPBI foram menores do que os escores dos dois outros grupos nas primeiras duas horas e menores do que os do grupo controle nos períodos de 4 e 6 horas (p < 0,05). No grupo IA, os escores EVAr e EVAm nos períodos de 2, 4 e 6 horas foram menores do que no grupo controle (p < 0,05). CONCLUSÃO: O bloqueio do plexo braquial por via interescalênica mostrou ser mais eficaz do que a injeção intra-articular de anestésico local para analgesia pós-operatória. .

JUSTIFICACIÓN Y OBJETIVOS: En este estudio, nuestro objetivo fue comparar en el período postoperatorio los efectos analgésicos de la administración de la bupivacaína en el bloqueo del plexo braquial por vía interescalénica guiado por ecografía y bupivacaína intraarticular. MÉTODOS: En el primer grupo de pacientes se administraron 20 mL de bupivacaína al 0,25% y se llevó a cabo el bloqueo del plexo braquial por vía interescalénica (BPBI) guiado por ecografía, mientras que al segundo grupo de pacientes se le administraron 20 mL de bupivacaína al 0,25% por vía intraarticular (IA) tras la cirugía. Los pacientes del tercer grupo fueron considerados como grupo control y en ellos no se realizó ningún bloqueo. La analgesia controlada por el paciente con morfina se usó en los 3 grupos para la analgesia postoperatoria. RESULTADOS: En el grupo BPBI, el consumo de morfina en los períodos entre 0-4, 6-12 y 12-24 h del postoperatorio y el consumo total en 24 h fueron más bajos que en los otros 2 grupos. El consumo de morfina en el grupo IA fue menor que en el grupo control en el período de 0-6 h, como también fue menor el consumo total de morfina en 24 h. Las puntuaciones EVAr en el postoperatorio del grupo BPBI fueron menores que las de los otros 2 grupos en las primeras 2 h y menores que los del grupo control en los períodos de 4 y 6 h (p < 0,05). En el grupo IA, las puntuaciones EVAr y EVAm en los períodos de 2, 4 y 6 h fueron menores que en el grupo control (p < 0,05). CONCLUSIÓN: El BPBI mostró ser más eficaz que la inyección intraarticular de anestésico local para analgesia postoperatoria. .

Ultrasound in brachial plexus block anesthesia application effect analysis / 中国基层医药

Objective To explore the application effect and safety of ultrasonic location in interscalene bra-chial plexus block anesthesia.Methods 100 cases with upper extremity orthopedic surgery patients were selected, according to the brachial plexus between the different positioning methods,they were divided into control group and observation group,50 cases in each group,the control group chose the traditional anatomical localization techniques, observation group interscalene under ultrasound guidance brachial plexus block,two groups of anesthesia were com-pared,block success rates and complications were observed.Results The block operation time,anesthesia onset time,duration of analgesia and anesthesia drug dosage of the observation group were (185.5 ±24.86)s,(11.55 ± 2.89)min,(11.42 ±2.39)min,(17.25 ±2.54)mL while the control group were (228.75 ±26.20)s,(16.05 ±4.66)min,(10.95 ±2.83)min,(19.50 ±2.79)mL,there was significant difference between two groups(t =18.34, 10.28,9.72,10.68,all P <0.05).the anesthesia success rate of the observation group was 98%,significantly higher than 88% of the control group,the difference between the two groups was statistically significant(χ2 =9.12,P <0.05).The incidence rate of complications in the observation group was 0,while the control group was 8%,two groups had significant difference in complication rate(χ2 =8.34,P <0.05).Conclusion Ultrasonic location in in-terscalene brachial plexus block anesthesia has a good clinical effect,with high safety,which is worthy of populariza-tion and application.

Pleural effusion and atelectasis during continuous interscalene brachial plexus block: A case report / 대한마취과학회지

An interscalene brachial plexus block is an effective means of providing anesthesia-analgesia for shoulder surgery. However, it has a multitude of potential side effects such as phrenic nerve block. We report a case of a patient who developed atelectasis of the lung, and pleural effusion manifested as chest discomfort during a continuous interscalene brachial plexus block for postoperative analgesia.

Comparison of intermittent versus continuous interscalene brachial plexus block for postoperative analgesia

BACKGROUND: Interscalene brachial plexus block (IBPB) is an effective method of postoperative analgesia after shoulder surgery. This study evaluates the effects and complications of IBPB with two different infusion methods (using intermittent bolus infusion versus automated continuous infusion). METHODS: Thirty six patients who were scheduled for shoulder surgery were randomly assigned into two groups (the continuous vs. intermittent groups). All the patients received preoperative IBPB using 15 ml of 0.25% ropivacaine followed by insertion of a 20 gauge catheter. This catheter was connected to a patient controlled analgesia (PCA) pump after the operation. The intermittent group (n = 18) received IBPB with 0.2% ropivacaine 100 ml (bolus 15 ml, lock time 4 h) without basal infusion. The continuous group (n = 18) received IBPB with 0.2% ropivacaine 100 ml (basal rate 4 ml/h) without bolus injection. All the patients were given meperidine 25 mg when the postoperative visual analogue score (VAS) >40 mm. The VAS, heart rate, noninvasive blood pressure, respiratory rate, consumption of meperidine and complications were measured during the 64 h following surgery at intervals of 8 h. RESULTS: The VAS was higher in the intermittent group than that in the continuous group at 24 h after surgery (P < 0.01).However, there was no significant difference for the VAS between the groups for the other assessment periods.There was no significant difference for the amount of meperidine consumed and the incidence of complications between the groups. CONCLUSIONS: Intermittent IBPB's analgesic effects and complications for treating pain after shoulder surgery are similar to those of continuous IBPB. Therefore, intermittent IBPB could be used for the management of pain after shoulder surgery.

The effect of sono-guided brachial plexus block on postoperative pain control for arthroscopic shoulder surgery: comparison with general anesthesia

BACKGROUND: Interscalene brachial plexus block (IS-BPB) offers many advantages over general anesthesia for both arthroscopic and open surgeries of the shoulder, including shorter hospital stay, reduced postoperative analgesia requirements, and avoidance of the risks and side effects of general anesthesia. The purpose of this study was to compare the effectiveness of postoperative pain control by IS-BPB to general anesthesia for performing arthroscopic shoulder surgery. METHODS: Sixty patients were divided into three groups: general anesthesia (group A, n=20), general anesthesia and suprascapular nerve block (SSNB) (group B, n=20), and only IS-BPB(group C, n=20). All patients received patient-controlled analgesia (PCA), and were instructed to rate their pain using a visual analogue scale (VAS) ranging from 0 to 10. VAS was measured at 1, 4, 8, 12, and 24 hours after surgery. Hospital stays were recorded. RESULTS: VAS decreased significantly with time in group A and B (P < 0.05) (Fig. 1), but not in group C. Group C had less pain at 1, 4, 8, 12, 24, hours postoperatively than the other groups (P < 0.05) (Fig. 1). Group C had shorter hospital stays than the other groups (P < 0.05) (Fig. 2). CONCLUSIONS: IS-BPB results in less postoperative pain and a shorter hospital stay than general anesthesia for arthroscopic shoulder surgery (P < 0.05).

The Effect of Preoperative Interscalene Block Using Low-Dose Mepivacaine on the Postoperative Pain after Shoulder Arthroscopic Surgery

BACKGROUND: Shoulder arthroscopic surgery is frequently associated with severe postoperative pain, which can be difficult to manage without the use of high-dose opioids. Although an interscalene brachial plexus block (ISBPB) can be used to provide anesthesia for shoulder arthroscopic surgery, its effect using low-dose mepivacaine on postoperative pain management has not been reported. We hypothesized that ISBPB using a low-dose mepivacaine can provide effective postoperative analgesia for shoulder arthroscopic surgery without the need for high-dose opioids and act as a significant motor or sensory block. METHODS: This study examined a total of 40 patients, who underwent shoulder arthroscopic surgery, and received ISBPB with 10 ml of normal saline (group NS; n = 20) or 10 ml of 1% mepivacaine with epinephrine 1:200,000 (group MC; n = 20). The block was performed preoperatively. The postoperative pain score, opioid consumption, and side effect were recorded. RESULTS: The visual analog scale scores were significantly lower in group MC than in group NS at 120 minutes after shoulder arthroscopic surgery (1.9 +/- 1.0 versus 4.0 +/- 1.4). Group MC showed significantly lower fentanyl consumption after shoulder arthroscoic surgery than group NS (27 +/- 32.6 versus 79 +/- 18.9microgram). The degree of motor and sensory block after surgery was minimal. CONCLUSIONS: ISBPB using low-dose mepivacaine reduced the level of postoperative pain and fentanyl consumption without significant side effects. ISBPB using low-dose mepivacaine is a useful analgesic technique for shoulder arthroscopic surgery.

Analgesic effect of low-dose levobupivacaine for ultrasound-guided interscalene brachial plexus block for arthroscopic shoulder surgery / 대한마취과학회지

BACKGROUND: Ultrasound guided-interscalene brachial plexus block (US-ISBPB) becomes more popular and has higher success rate. The aim of this study was to assess the analgesic effectiveness of US-ISBPB with low dose levobupivacaine for arthroscopic shoulder surgery. METHODS: The thirty patients undergoing elective arthroscopic shoulder surgery were randomly assigned to two groups: Group B(0.5), and Group B(0.25) received ultrasound-guided ISBPB using same volume 10 ml of 0.5% levobupivacaine and 0.25% levobupivacaine, respectively. General anesthesia was standardized. All patients received continuous intra-articular infusion of a local anesthetic. Remifentanil consumption during operation, verbal numerical rating scales (VNRS) after operation were assessed. The need for rescue analgesics in post-anesthesia care unit (PACU), sleep quality, and complications were documented. RESULTS: There were no significant differences in VNRS at 20 min, 30 min, 60 min, 120 min, 8 h, 24 h after surgery, remifentanil consumption during operation, the number of patients required rescue analgesics in the PACU, sleep quality, and complication up to 24 h after surgery. CONCLUSIONS: Ultrasound-guided interscalene brachial plexus block with levobupivacaine, 10 ml of 0.5% and 0.25%, provides effective analgesia after arthroscopic shoulder surgery.

Intermittent Interscalene Brachial Plexus Block vs. Continuous Intraarticular Infusion for the Management of Postoperative Pain after Shoulder Surgery

BACKGROUND: Severe postoperative pain is a well-known problem following shoulder surgery. This study evaluates the clinical efficacy of intermittent interscalene brachial plexus block (ISBPB) compared with that of continuous intraarticular infusion (IAPCA) for the management of postoperative pain after shoulder surgery. METHODS: Fifty seven patients, scheduled for shoulder surgery during general anesthesia, were randomly allocated to one of two groups. Group ISBPB (n = 19) received a preoperative interscalene brachial plexus block using 20 ml of 0.5% bupivacaine followed by insertion of a 20-gauge polyamide catheter. This catheter was connected to a patient-controlled analgesia pump set immediately after surgery to administer a bolus of 0.75% ropivacaine 15 ml at lockout time intervals 8 hours. Group IAPCA (n = 38) received patient- controlled analgesia with 0.2% ropivacaine 100 ml (basal rate 2 ml/hr, bolus 0.5 ml, lockout time 15 min). Both groups received intravascular patient-controlled analgesia with fentanyl 10? 15 microg/ml (basal rate 1 ml/hr, bolus 2 ml, lockout time 15 min). All patients were given pethidine 25 or 50 mg when visual analogue score (VAS) >40 mm. VAS, circulatory and respiratory stress parameter (heart rate, noninvasive blood pressure and respiratory rate) and consumption of pethidine were measured during 72 hours following surgery at intervals of 8 hours. RESULTS: The mean VAS scores in the ISBPB group were significantly lower than in the IAPCA group for 72 hr after surgery (P < 0.01). Pethidine consumption in the ISBPB group was significantly lower than in the IAPCA group (P < 0.01). CONCLUSIONS: We concluded that intermittent interscalene brachial plexus block is an effective method of postoperative analgesia after major shoulder surgery.

Bilateral Interscalene Brachial Plexus Block for Surgery on Both Upper Extremities in a Patient with Unilateral Vocal Cord Paralysis : A case report

The interscalene approach of the brachial plexus block is a common technique for surgery on the upper extremities as it provides good intraoperative anesthesia and postoperative analgesia. However, bilateral blockade of both brachial plexuses has rarely been performed because it could lead to respiratory insufficiency and local anesthetic toxicity owing to the large amount of drug administered. We report a case of a successful bilateral interscalene brachial plexus block in a patient with unilateral vocal cord paralysis observed after a conventional endotracheal intubation.

Effects of Interscalene Brachial Plexus Block Combined with Patient Controlled Analgesia in a Patient with CRPS: A case report / 대한마취과학회지

Complex regional pain syndrome (CRPS) is a condition characterized by regional pain, sensory alterations, motor dysfunction, and abnormality in body temperature, sudomotor activation, skin color changes and regional edema which often appears in the extremities after the onset of a noxious event. CRPS is a disabling disorder with an unknown mechanism. We present a CRPS case which is extremely resistant to conventional pharmaceutical and other therapeutic treatments in the left upper limb, which was treated successfully with continuous interscalene brachial plexus block (BPB).

Spinal Cord Injury Occurred during the Brachial Plexus lock in a Patient with Ankylosing pondylitis: A case report / 대한마취과학회지

The brachial plexus block by interscalene approach is useful for any procedure on upper extremity, including the shoulder. Complications such as phrenic nerve block, Horner's syndrome, permanent neurologic damage, high epidural block, total spinal anesthesia, pneumothorax and cardiac arrest etc. were reported. We experienced a case of 56-year old male patient with ankylosing spondylitis who developed cervical spinal cord injury following the turning of head for brachial plexus block by interscalene approach. The patient developed quadriplegia and finally died after 28 days.

Prolonged Horner's Syndrome Following Interscalene Brachial Plexus Block: A case report / 대한마취과학회지

The brachial plexus block by interscalene approach is useful for any procedure on upper extremity, including the shoulder. Complications such as high epidural block, total spinal anesthesia, permanent neurologic damage, phrenic nerve block, cardiac arrest, pneumothorax and Horner's syndrome etc. were reported. Ipsilateral Horner' syndrome can be used for confirmation of the accompanying sympathetic block. We experienced a case of 35-year old male patient who developed ipsilateral Horner's syndrome following the injection of 40ml of 1% lidocaine with 1 : 200,000 epinephrine to brachial plexus by interscalene approach. This compication lasted for 10days after interscalene brachial plexus block.