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The middle interscalene block: cadaver study and clinical assessment
Fernando Alemanno1, Giuseppe Capozzoli, Eduard Egarter-Vigl
1Department of Anesthesiology, Moro-Girelli Hospital, Don Carlo Gnocchi Foundation, Brescia, Italy. fernando@alemannobpb.it
Regional Anesthesia and Pain Medicine
|December 2, 2006
Summary
A new middle interscalene brachial plexus block technique is effective for shoulder surgery, achieving a 96.2% success rate. This method uses reliable bony landmarks when the subclavian artery pulse is not palpable, minimizing severe complications.
Area of Science:
- Anesthesiology
- Regional Anesthesia
- Surgical Procedures
Background:
- The interscalene approach is common for brachial plexus blocks.
- Variations exist, necessitating refined techniques for improved safety and efficacy.
Purpose of the Study:
- To introduce and evaluate a novel middle interscalene perivascular approach for brachial plexus block.
- To assess the accuracy of bony landmarks for guiding needle placement when the subclavian artery pulse is impalpable.
Main Methods:
- A new technique involving needle insertion lateral to the subclavian artery pulse, directed towards the C7 vertebra.
- Use of three bony landmarks (mid-clavicle, C7 spinous process, sternoclavicular joint) to guide needle trajectory when pulse is absent.
- Prospective study of 719 patients undergoing shoulder arthroscopy and cadaveric simulation for landmark validation.
Main Results:
- High success rate of 96.2% (692/719) for the brachial plexus block.
- Low incidence of complications: <1% arterial puncture with hematoma, <1% transient respiratory failure, <1% laryngeal nerve block.
- Zero severe complications or permanent injuries reported (upper 95% CI = 0.4%).
Conclusions:
- The described middle interscalene perivascular approach is effective and easy to perform.
- Bony landmarks provide reliable guidance for needle insertion, even without palpable pulse.
- The technique appears to avoid specific complications associated with other approaches, such as pneumothorax or vertebral artery injection.
