POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF...
-
Upload
derick-perkins -
Category
Documents
-
view
216 -
download
1
Transcript of POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF...
![Page 1: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/1.jpg)
POSTERIOR INTERSCALENE BLOCKPOSTERIOR INTERSCALENE BLOCKErcan KURT
GÜLHANE MILITARY MEDICAL FACULTYDEPARTMENT OF ANESTHESIOLOGY AND REANIMATION
ANKARA
![Page 2: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/2.jpg)
INTERSCALENE BRACHIAL PLEXUS INTERSCALENE BRACHIAL PLEXUS BLOCKBLOCK
ANTERIOR APPROACH•SINGLE – DOSE TECHNIQUE•CATHETER TECHNIQUE
POSTERIOR APPROACH•SINGLE – DOSE TECHNIQUE•CATHETER TECHNIQUE
![Page 3: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/3.jpg)
₡ INDICATIONSShoulder and upper arm surgery
Immobility of shoulder joint
Shoulder manipulations
Chronic pain therapy
Arthroscopic shoulder surgery
₡ ADVANTAGES Easily performed in any position of the arm
₡ DISADVANTAGES Ulnar nerve may not be blocked Serious complications may occur
INTERSCALENE BRACHIAL PLEXUS INTERSCALENE BRACHIAL PLEXUS BLOCKBLOCK
![Page 4: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/4.jpg)
ISB CONTRAINDICATIONSISB CONTRAINDICATIONS
¥ Skin infection
¥ Refusal of the procedure by the patient
¥ Haemorrhagic diathesis
¥ Contralateral phrenic nerve or recurrent nerve paralysis
¥ Known neuropathy involving the arm undergoing
surgery
¥ Severe bronchopulmonary disease
¥ Known allergy to the trial drugs
¥ Previous neurologic damage to the brachial plexus
![Page 5: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/5.jpg)
INTERSCALENE BLOCKINTERSCALENE BLOCK
ANATOMY OF ANATOMY OF BRACHIAL PLEXUSBRACHIAL PLEXUS
![Page 6: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/6.jpg)
Subclavian v.
Subclavian a.
Phrenic nerve
V.J.Interna
A. C.Communis
![Page 7: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/7.jpg)
Subclavian a-v
Anterior and middle scalene
Cupola of lung
![Page 8: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/8.jpg)
Vertebral a.
Phrenic nerve
SCM muscleAnterior scalene
m.
Middle scalene m.
Subclavian a.
![Page 9: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/9.jpg)
ANATOMICAL LANDMARKS ANATOMICAL LANDMARKS OF BRACHIAL PLEXUSOF BRACHIAL PLEXUS
Arteria carotis communis Apex of lung Phrenic nerve
![Page 10: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/10.jpg)
LOCAL ANESTHETICS MAY SPREAD LOCAL ANESTHETICS MAY SPREAD INTO SUBARACHNOIDAL SPACE INTO SUBARACHNOIDAL SPACE
THROUGH THREE WAYSTHROUGH THREE WAYS
1- INTERVERTEBRAL FORAMEN2- DURAL SHEATH 3- INTRANEURALLY
![Page 11: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/11.jpg)
SINGLE - DOSE ISB USING SINGLE - DOSE ISB USING POSTERIOR APPROACHPOSTERIOR APPROACH
![Page 12: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/12.jpg)
1- Skin-subcutaneous tissue
2- M. trapezius
3- M. splenius capitis
4- M. semispinalis capitis
5- M. semispinalis cervitis
6- M. scaleneus posterior
7- M. scaleneus medius
ISB USING POSTERIOR APPROACHISB USING POSTERIOR APPROACH ANATOMICAL LAYERS IN ANATOMICAL LAYERS IN
TRANSVERSE SECTIONTRANSVERSE SECTION
![Page 13: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/13.jpg)
C-7 SPINOUS PROCESS BRACHIAL PLEXUS
ISB USING POSTERIOR ISB USING POSTERIOR APPROACHAPPROACH
![Page 14: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/14.jpg)
POSTERIOR ISBPOSTERIOR ISB
SITTING POSITIONSITTING POSITION LATERAL DECUBITIS POSITIONLATERAL DECUBITIS POSITION
![Page 15: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/15.jpg)
SINGLE - DOSE ISB USING SINGLE - DOSE ISB USING POSTERIOR APPROACH POSTERIOR APPROACH
![Page 16: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/16.jpg)
SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH
![Page 17: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/17.jpg)
SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH
![Page 18: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/18.jpg)
SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH
![Page 19: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/19.jpg)
SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH
![Page 20: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/20.jpg)
SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH
![Page 21: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/21.jpg)
SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH
![Page 22: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/22.jpg)
SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH
![Page 23: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/23.jpg)
SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH
![Page 24: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/24.jpg)
SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH
![Page 25: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/25.jpg)
SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH
![Page 26: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/26.jpg)
SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH SINGLE - DOSE ISB USING POSTERIOR APPROACH
![Page 27: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/27.jpg)
LOCAL ANESTHETICS FOR ISBLOCAL ANESTHETICS FOR ISB
A TOTAL VOLUME OF 40 – 50 MLA TOTAL VOLUME OF 40 – 50 ML
20 -25 ml 0,5 % 20 -25 ml 0,5 % bupivacaine + 20 - 25 ml 1 % prilocainebupivacaine + 20 - 25 ml 1 % prilocaine 20 - 25ml 0,5 % 20 - 25ml 0,5 % bupivacaine + 20 - 25 ml 1 % lignocainebupivacaine + 20 - 25 ml 1 % lignocaine 20 - 25ml 0,2 %20 - 25ml 0,2 %ropivacaine + 20 - 25 ml 1 % lignocaineropivacaine + 20 - 25 ml 1 % lignocaine
![Page 28: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/28.jpg)
INDICATIONS FOR CATHETER INDICATIONS FOR CATHETER
Acute pain therapy (postoperative) Management of chronic pain (CRPS) Supportive adjunct to physiotherapy/exercise
therapy Sympatholysis (for improving wound healing) Preventive analgesia (phantom pain prophylaxis)
![Page 29: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/29.jpg)
CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH
![Page 30: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/30.jpg)
CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH
![Page 31: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/31.jpg)
CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH
![Page 32: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/32.jpg)
CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH
![Page 33: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/33.jpg)
CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH
![Page 34: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/34.jpg)
CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH
![Page 35: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/35.jpg)
CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH
![Page 36: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/36.jpg)
CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH
![Page 37: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/37.jpg)
CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH
![Page 38: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/38.jpg)
CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH
![Page 39: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/39.jpg)
CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH
![Page 40: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/40.jpg)
CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH CONTINUOUS ISB USING POSTERIOR APPROACH
![Page 41: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/41.jpg)
STIMULATING CATHETERSSTIMULATING CATHETERS
• Does Interscalene Catheter Placement with Does Interscalene Catheter Placement with Stimulating Catheters Improve Postoperative Stimulating Catheters Improve Postoperative Pain or Functional Outcome After Shoulder Pain or Functional Outcome After Shoulder Surgery? Surgery? Regional Anest Vol 104(2) 2007Regional Anest Vol 104(2) 2007
Stevens M.F.Stevens M.F.
Precisely control catheter placementPrecisely control catheter placementImproved onset of motor nerve blockImproved onset of motor nerve block
![Page 42: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/42.jpg)
Brachial Plexus Block With Catheter Brachial Plexus Block With Catheter Using The Posterior Interscalene Using The Posterior Interscalene
ApproachApproach
• In The Management Of Neuropathic Cancer Pain (2 Case Report)TÜRKER G. TÜRKER G.
Uludağ Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon AD, BURSAUludağ Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon AD, BURSA
Decreased likelihood of catheter Decreased likelihood of catheter dislodgement due to neck movementdislodgement due to neck movement
![Page 43: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/43.jpg)
ISB COMPLICATIONSISB COMPLICATIONS Horner syndrome N. recurrens paralysis Phrenic nerve paralysis Bronchospasm Total spinal anesthesia Acute respiratory insufficiency Contralateral anesthesia Loss of consciousness and apnea Hematoma Nerve injury
![Page 44: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/44.jpg)
ACCIDENTAL EPIDURAL ACCIDENTAL EPIDURAL CATHETERIZATIONCATHETERIZATION
• During continuous interscalene block via the posterior approach
Gurbet A.
2005 Journal The Pain Clinic
5 ml of contrast medium were injected and a C-arm fluoroscopic
imaging showed contrast medium in the epidural space with catheter opacification
•the patient should be awake and conscious during catheter placement
•radiographic confirmation of catheter position should be
obtained before the first injection
•after each local anesthetic injection the patient should be monitored.
![Page 45: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/45.jpg)
INTRACORD INJECTION
• Permanent Loss of Cervical Spinal Cord Function Associated with Interscalene
Block Performed Under General Anesthesia
• Benumof Jonathan L• Volume 93(6), December 2000, 1541- 4
![Page 46: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/46.jpg)
How to Prevent Catastrophic How to Prevent Catastrophic Complications When Performing ISBComplications When Performing ISB
In our institution, we only perform interscalene blocks before or after surgery in awake patients
![Page 47: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/47.jpg)
PRECAUTIONS IN ISB
ISB should not be performed in patients with a history including contralateral hemidiaphragmatic paralysis, pneumothorax and pneumonectomy
The patients who can not tolerate a 25 % reduction of FVC are not appropriate for ISB
Pulse oxymetry should be used
Supplemental nazal oxygen should be given
![Page 48: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/48.jpg)
IN CASE OF DISPNEA AFTER ISBIN CASE OF DISPNEA AFTER ISB
The patient should be closely observed
Patient is positioned in reverse Trendelenburg or sitting
position
Breath sounds should be oscultated to evaluate
diaphragmatic hemiparesis
A chest radiogram is required to check pneumothorax
Ventilatory support or endotracheal intubation is indicated, if
necessary
![Page 49: POSTERIOR INTERSCALENE BLOCK Ercan KURT GÜLHANE MILITARY MEDICAL FACULTY DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION ANKARA.](https://reader031.fdocuments.net/reader031/viewer/2022013004/56649cd65503460f9499d650/html5/thumbnails/49.jpg)
AS A RESULTAS A RESULT
₪Prevention of these complications includes the proper selection of patients
₪The performance of blocks either before or after anesthesia in patients who are awake or mildly sedated