Continuous interscalene block for ambulatory shoulder surgery

Management of acute post-operative pain due to shoulder surgery may be successfully and consistently achieved in ambulatory patients by using continuous interscalene block. This chapter outlines the anterior and posterior approaches to the proximal brachial plexus and describes a method of precisely placing a catheter along the brachial plexus by stimulating the plexus through the needle used for placing the catheter as well as through the catheter itself. A technique for securing the catheter by subcutaneous tunneling to prevent dislodgement is also described. Suggested drugs and dosages for initial boluses, continuous infusions and patient controlled interscalene analgesia are discussed. Sedation for block placement, and special precautions, are outlined.