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New technique targeting the C5 nerve root proximal to the traditional interscalene sonoanatomical approach is analgesic for outpatient arthroscopic shoulder surgery.
J Clin Anesth. 2016 Nov; 34:79-84.JC

Abstract

STUDY OBJECTIVE

Regional anesthesia and analgesia for shoulder surgery is most commonly performed via interscalene nerve block. We developed an ultrasound-guided technique that specifically targets the C5 nerve root proximal to the traditional interscalene block and assessed its efficacy for shoulder analgesia.

DESIGN

Prospective case series.

SETTING

Vanderbilt Bone and Joint Surgery Center.

PATIENTS

Patients undergoing shoulder arthroscopy at an ambulatory surgery center.

INTERVENTIONS

Thirty-five outpatient shoulder arthroscopy patients underwent an analgesic nerve block using a new technique where ultrasound visualization of the C5 nerve root served as the primary target at a level proximal to the traditional interscalene approach. The block was performed with 15mL of 0.5% plain ropivicaine.

MEASUREMENTS

Post anesthesia care unit pain scores, opioid consumption, hand strength, and duration of block were recorded. Cadaver dissection after injection with methylene blue confirmed that the primary target under ultrasound visualization was the C5 nerve root.

MAIN RESULTS

Pain scores revealed 97% patients had 0/10 pain at arrival to PACU, with 91% having a pain score of 3/10 or less at discharge from PACU. Medical Research Council (MRC) hand strength mean (SD) score was 4.17 (0.92) on a scale of 1-5. The mean (SD) duration of the block was 13.9 (3.5) hours.

CONCLUSIONS

A new technique for ultrasound-guided blockade at the level of the C5 nerve root proximal to the level of the traditional interscalene block is efficacious for shoulder post-operative pain control.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Dobie KH
Vanderbilt University School of Medicine. Electronic address: katherine.hines@vanderbilt.edu.
Shi Y
Vanderbilt University School of Medicine. Electronic address: yaping.shi@Vanderbilt.Edu.
Shotwell MS
Vanderbilt University School of Medicine. Electronic address: matt.shotwell@Vanderbilt.Edu.
Sandberg WS
Vanderbilt University School of Medicine. Electronic address: warren.sandberg@Vanderbilt.Edu.

MeSH

Ambulatory Surgical ProceduresAmidesAnesthetics, LocalArthroscopyBrachial PlexusBrachial Plexus BlockCadaverDissectionFeasibility StudiesFemaleHand StrengthHumansMaleMiddle AgedPain MeasurementPain, PostoperativeProspective StudiesRopivacaineShoulderTreatment OutcomeUltrasonography, Interventional

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

27687351

Citation

Dobie, Katherine H., et al. "New Technique Targeting the C5 Nerve Root Proximal to the Traditional Interscalene Sonoanatomical Approach Is Analgesic for Outpatient Arthroscopic Shoulder Surgery." Journal of Clinical Anesthesia, vol. 34, 2016, pp. 79-84.
Dobie KH, Shi Y, Shotwell MS, et al. New technique targeting the C5 nerve root proximal to the traditional interscalene sonoanatomical approach is analgesic for outpatient arthroscopic shoulder surgery. J Clin Anesth. 2016;34:79-84.
Dobie, K. H., Shi, Y., Shotwell, M. S., & Sandberg, W. S. (2016). New technique targeting the C5 nerve root proximal to the traditional interscalene sonoanatomical approach is analgesic for outpatient arthroscopic shoulder surgery. Journal of Clinical Anesthesia, 34, 79-84. https://doi.org/10.1016/j.jclinane.2016.03.064
Dobie KH, et al. New Technique Targeting the C5 Nerve Root Proximal to the Traditional Interscalene Sonoanatomical Approach Is Analgesic for Outpatient Arthroscopic Shoulder Surgery. J Clin Anesth. 2016;34:79-84. PubMed PMID: 27687351.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - New technique targeting the C5 nerve root proximal to the traditional interscalene sonoanatomical approach is analgesic for outpatient arthroscopic shoulder surgery. AU - Dobie,Katherine H, AU - Shi,Yaping, AU - Shotwell,Matthew S, AU - Sandberg,Warren S, Y1 - 2016/05/03/ PY - 2015/02/24/received PY - 2016/03/13/revised PY - 2016/03/16/accepted PY - 2016/10/1/entrez PY - 2016/10/1/pubmed PY - 2017/7/18/medline KW - Ambulatory surgery KW - C5 nerve root block KW - Interscalene nerve block KW - New technique KW - Regional anesthesia KW - Shoulder analgesia SP - 79 EP - 84 JF - Journal of clinical anesthesia JO - J Clin Anesth VL - 34 N2 - STUDY OBJECTIVE: Regional anesthesia and analgesia for shoulder surgery is most commonly performed via interscalene nerve block. We developed an ultrasound-guided technique that specifically targets the C5 nerve root proximal to the traditional interscalene block and assessed its efficacy for shoulder analgesia. DESIGN: Prospective case series. SETTING: Vanderbilt Bone and Joint Surgery Center. PATIENTS: Patients undergoing shoulder arthroscopy at an ambulatory surgery center. INTERVENTIONS: Thirty-five outpatient shoulder arthroscopy patients underwent an analgesic nerve block using a new technique where ultrasound visualization of the C5 nerve root served as the primary target at a level proximal to the traditional interscalene approach. The block was performed with 15mL of 0.5% plain ropivicaine. MEASUREMENTS: Post anesthesia care unit pain scores, opioid consumption, hand strength, and duration of block were recorded. Cadaver dissection after injection with methylene blue confirmed that the primary target under ultrasound visualization was the C5 nerve root. MAIN RESULTS: Pain scores revealed 97% patients had 0/10 pain at arrival to PACU, with 91% having a pain score of 3/10 or less at discharge from PACU. Medical Research Council (MRC) hand strength mean (SD) score was 4.17 (0.92) on a scale of 1-5. The mean (SD) duration of the block was 13.9 (3.5) hours. CONCLUSIONS: A new technique for ultrasound-guided blockade at the level of the C5 nerve root proximal to the level of the traditional interscalene block is efficacious for shoulder post-operative pain control. SN - 1873-4529 UR - https://www.unboundmedicine.com/medline/citation/27687351/New_technique_targeting_the_C5_nerve_root_proximal_to_the_traditional_interscalene_sonoanatomical_approach_is_analgesic_for_outpatient_arthroscopic_shoulder_surgery_ DB - PRIME DP - Unbound Medicine ER -
Grapherence [↓3]

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