Abstract
The skin over the neck and proximal shoulder is supplied by the superficial cervical plexus including the supraclavicular nerve (C3–C4) which innervates the skin above and below the clavicle. While the suprascapular nerve innervates the posterior shoulder, primary innervation of the shoulder occurs via the axillary nerve (Figs. 1 and 2). Both the axillary and suprascapular nerves consist of fibers from the most cephalad contributions to the brachial plexus (C5 and C6) (Fig. 3). Effective approaches to analgesia for shoulder surgery target the brachial plexus at the level of the upper roots/proximal trunks (interscalene block) and distal trunks/divisions (supraclavicular block) (Fig. 4).
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References
Liu S, Gordon M, Shaw P, et al. A prospective clinical registry of ultrasound-guided regional anesthesia for ambulatory shoulder surgery. Anesth Analg. 2010;111:617–23.
Singelyn FJ, L’hotel L, Fabre B. Pain relief after arthroscopic shoulder surgery: a comparison of intra-articular analgesia, suprascapular nerve block, and interscalene brachial plexus block. Anesth Analg. 2004;99:589–92.
Urmey WF, Talts KH, Sharrock NE. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesth Analg. 1991;72:498–503.
Urmey WF, McDonald M. Hemidiaphragmatic paresis during interscalene brachial plexus block: effects on pulmonary function and chest wall mechanics. Anesth Analg. 1992;74:352–7.
Verelst P, van Zundert A. Respiratory impact of analgesic strategies for shoulder surgery. Reg Anesth Pain Med. 2013;38:50–3.
Bernards CM, Hadzic A, Suresh S, Neal JM. Regional anesthesia in anesthetized or heavily sedated patients. Reg Anesth Pain Med. 2008;33:449–60.
Gauss A, Tugtekin I, Georgieff M, et al. Incidence of clinically symptomatic pneumothorax in ultrasound-guided infraclavicular and supraclavicular brachial plexus block. Anaesthesia. 2014;69:327–36.
Abell DJ, Barrington MJ. Pneumothorax after ultrasound-guided supraclavicular block: presenting features, risk, and related training. Reg Anesth Pain Med. 2014;39:164–7.
Abdallah F, Halpern S, Aoyama K, Brull R. Will the real benefits of single-shot interscalene block please stand up? A systematic review and meta-analysis. Anesth Analg. 2015;120:1114–29.
Fredrickson MJ, Ball CM, Dalgleish AJ. Analgesic effectiveness of a continuous versus single injection interscalene block for minor arthroscopic shoulder surgery. Reg Anesth Pain Med. 2010;35:28–33.
Goebel S, Stehle J, Schwemmer U, et al. Interscalene brachial plexus block for open-shoulder surgery: a randomized, double blind placebo-controlled trial between single-shot anesthesia and patient- controlled catheter system. Arch Orthop Trauma Surg. 2010;130:533–40.
Fredrickson M, Kilfoyle D. Neurological complication analysis of 1000 ultrasound guided peripheral nerve blocks for elective orthopaedic surgery: a prospective study. Anaesthesia. 2009;64:836–44.
Dwyer T, Henry P, Cholvisudhu P, et al. Neurological complications related to elective orthopedic surgery. Part 1: common shoulder and elbow procedures. Reg Anesth Pain Med. 2015;40:431–42.
Moayeri N, Bigeleisen P, Groen G. Quantitative architecture of the brachial plexus and surrounding compartments, and their possible significance for plexus blocks. Anesthesiology. 2008;108:299–304.
Tran DQ, Tiyaprasertkul W, González AP. Analgesia for clavicular fracture and surgery: a call for evidence. Reg Anesth Pain Med. 2013;38:539–43.
Webb D, Guttmann D, Cawley P, Lubowitz J. Continuous infusion of local anesthetic versus interscalene block for postoperative pain control after arthroscopic shoulder surgery. Arthroscopy. 2007;23:1006–11.
Busfield BT, Romero DM. Pain pump use after shoulder arthroscopy as a cause of glenohumeral chondrolysis. Arthroscopy. 2009;25:647–52c.
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© 2016 Springer International Publishing Switzerland
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Luke, C., Umeh, U., Harrington, B. (2016). Regional Analgesia for Shoulder Surgery. In: Scuderi, G., Tria, A. (eds) Minimally Invasive Surgery in Orthopedics. Springer, Cham. https://doi.org/10.1007/978-3-319-34109-5_7
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DOI: https://doi.org/10.1007/978-3-319-34109-5_7
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