Overview

Brachial Plexus BlocksInterscalene and Brachial Plexus Blocks are procedures performed by your anesthetist (anesthesiologists or nurse anesthetist), before your shoulder surgery, which numbs your shoulder and most of your arm.

WHAT ARE THE BENEFITS?

  • When successful, it provides excellent long-term pain relief on the day of your shoulder surgery, and may further reduce your pain during the rehabilitation period, even after the numbness wears off.
  • This pain control allows you to be sent home on the day of surgery.
  • This block reduces the need for strong narcotics normally used to control your pain after surgery, which have adverse side effects, such as nausea, itching, drowsiness, and “sluggish” bowel and bladder function.

When is it not recommended?

  • Patients who are heavy smokers, have lung disease, diaphragm paralysis or obesity. (These patients may have some difficulty breathing after the block).
  • Patients who are not willing to consent to the procedure (This is an optional procedure).
  • Patients who have true allergies to local anesthetics Patients with anatomic changes/deformities, tumors or infection involving the neck.

How is it done?

After meeting with your anesthetist in the “Preoperative Area” a few minutes before surgery, he/she will first relieve some of your pain and anxiety with IV Sedation. While lying on a cot with your head turned to the side and with your arms by your side (comfortable position for shoulder pain), the anesthetist will pass a small needle through the skin of your neck, just above the collarbone on the operative side. To ensure proper placement, she/she will often use a “nerve stimulator”, which will cause your arm or hand to temporarily twitch. Then the “local anesthetic” is injected and the twitching will stop. Your arm and shoulder will gradually become numb. This procedure can produce brief pain in the arm during the placement of the needle, but is generally well tolerated. Usually you will be asleep with IV Sedation. Occasionally, the block will not work sufficiently to be the primary anesthetic, or to effectively reduce post operative pain.

Side Effects

Common, usually last less than 24 hours

  • Hoarse Voice
  • Shortness of breath when laying flat
  • Watery bloodshot eyes, droopy eyelids

Complications (Rare)

  • Bleeding (minor bruising or soreness are more common)
  • Infections
  • Nerve Injury
  • Collapsed Lung
  • Accidental epidural or spinal anesthesia
  • Drug Toxicity due to accidental injection into a blood vessel or delayed absorption, possibly causing seizures, unconsciousness or heart irregularities
  • Voice Injury

Post Operative Recommendations

1st night only

  • Sleep in a recliner or in bed with your head and shoulders propped-up on pillows (pad the arm). This will help you breathing and reduce shoulder swelling. This also prevents you from sleeping on the numb arm, because prolonged pressure on the arm, particularly on the elbow, may lead to permanent nerve injury. (Follow your surgeon’s postoperative instructions).
  • Keep the affected arm in a sling, pad pressure points and protect from injury until numbness wears off.
  • Call your physician or anesthetist for any problems or concerns.
Brachial Plexus Blocks

Overview

Interscalene and Brachial Plexus Blocks are procedures performed by your anesthetist (anesthesiologists or nurse anesthetist), before your shoulder surgery, which numbs your shoulder and most of your arm.

WHAT ARE THE BENEFITS?

  • When successful, it provides excellent long-term pain relief on the day of your shoulder surgery, and may further reduce your pain during the rehabilitation period, even after the numbness wears off.
  • This pain control allows you to be sent home on the day of surgery.
  • This block reduces the need for strong narcotics normally used to control your pain after surgery, which have adverse side effects, such as nausea, itching, drowsiness, and “sluggish” bowel and bladder function.

When is it not recommended?

  • Patients who are heavy smokers, have lung disease, diaphragm paralysis or obesity. (These patients may have some difficulty breathing after the block).
  • Patients who are not willing to consent to the procedure (This is an optional procedure).
  • Patients who have true allergies to local anesthetics Patients with anatomic changes/deformities, tumors or infection involving the neck.

How is it done?

After meeting with your anesthetist in the “Preoperative Area” a few minutes before surgery, he/she will first relieve some of your pain and anxiety with IV Sedation. While lying on a cot with your head turned to the side and with your arms by your side (comfortable position for shoulder pain), the anesthetist will pass a small needle through the skin of your neck, just above the collarbone on the operative side. To ensure proper placement, she/she will often use a “nerve stimulator”, which will cause your arm or hand to temporarily twitch. Then the “local anesthetic” is injected and the twitching will stop. Your arm and shoulder will gradually become numb. This procedure can produce brief pain in the arm during the placement of the needle, but is generally well tolerated. Usually you will be asleep with IV Sedation. Occasionally, the block will not work sufficiently to be the primary anesthetic, or to effectively reduce post operative pain.

Side Effects

Common, usually last less than 24 hours

  • Hoarse Voice
  • Shortness of breath when laying flat
  • Watery bloodshot eyes, droopy eyelids

Complications (Rare)

  • Bleeding (minor bruising or soreness are more common)
  • Infections
  • Nerve Injury
  • Collapsed Lung
  • Accidental epidural or spinal anesthesia
  • Drug Toxicity due to accidental injection into a blood vessel or delayed absorption, possibly causing seizures, unconsciousness or heart irregularities
  • Voice Injury

Post Operative Recommendations

1st night only

  • Sleep in a recliner or in bed with your head and shoulders propped-up on pillows (pad the arm). This will help you breathing and reduce shoulder swelling. This also prevents you from sleeping on the numb arm, because prolonged pressure on the arm, particularly on the elbow, may lead to permanent nerve injury. (Follow your surgeon’s postoperative instructions).
  • Keep the affected arm in a sling, pad pressure points and protect from injury until numbness wears off.
  • Call your physician or anesthetist for any problems or concerns.

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