Block It Like It’s Hot: Regional Anesthesia, Pain Medicine & POCUS S1:E10 "Giving You the Cold Shoulder (Nerve blocks for Shoulder Surgery from Awake to Phrenic-Free)"
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Sep 29, 2023 Shoulder surgery blocks and techniques are explored in this episode, including innervation, brachial plexus blocks, and the controversy surrounding terminology. Pain management techniques and the use of adjuvants are also discussed, along with awake shoulder surgery techniques and monitoring methods.
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Peri‑plexus Over Intra‑plexus For Safety
- Do favor a peri-plexus approach for interscalene blocks to reduce intrafascicular injection risk.
- Aim between middle scalene epimysium and the plexus sheath rather than penetrating the sheath.
Suprascapular Dominates Shoulder Innervation
- The suprascapular nerve provides the dominant sensory input to the shoulder and often explains most analgesia.
- Combining suprascapular plus axillary approaches approximates an interscalene in effect for many procedures.
Small Distances, Wide Diffusion
- Local anesthetic diffuses widely, so injections several millimeters from nerves can still succeed.
- You do not need large volumes if you place injectate accurately under ultrasound.