15thAnnualPainMedicineMeeting

Thursday,November17,2016Saturday,November19,2016
SanDiegoCA

Abstract: 2814
Scientific abstract: Regional anesthesia

Interscalene brachial plexus blocks for shoulder surgery:

presentation of changes in practice over eight years in a
UK tertiary orthopaedic centre
Lance Holman, Vassilis Athanassoglou, Stuart Benham, Jonathan Chantler
Oxford University Hospitals NHS Foundation Trust

Introduction
Peripheral regional anaesthesia is an integral component of modern perioperative care. Ultrasonography enables more accurate needle
localization and has improved the capability of anaesthetists to achieve a high success rate with peripheral regional anaesthetic techniques. Our
aim was to examine the practical development of expertise for interscalene nerve blocks in a single centre setting through sequential, prospective
audit over an eight year period.

Materials and methods (NA for case report)

A total of 201 interscalene nerve blocks (ISB) were performed within the four audit cycles from 2007 to 2014. Patients pain scores and analgesia
requirements were recorded prior to discharge from recovery. Patients were then contacted by telephone on postoperative day three, when a
standardised telephone interview was used to gather information on the daily pain scores, any side effects experienced, the use of analgesia and
block duration. In the first audit cycle no ultrasound guidance was used, in contrast to the following three audits where it was used for all nerve
blocks.

Results/Case report
The results show a trend towards increased block success over the four audit cycles but this failed to reach statistical significance as determined by
chi-square test X2 (3,n=201)=0.05, p=0.14. Over the four audit cycles there was a statistically significant reduction in the dose of bupivacaine used, as
determined by one-way ANOVA (F(3,200)=14.0695, p<0.01). Despite the reduction in bupivacaine dose, the length of successful blocks showed a trend
towards increased duration, although this narrowly failed to reach statistical significance as determined by one-way ANOVA (F(3,200)=2.3101,
p=0.08).

Discussion
This study describes the introduction of ultrasound guidance for interscalene brachial plexus blockade to a single weekly anaesthetic list. The main
finding is that the development of expertise appeared to be a gradual process, taking years even in a setting where each anaesthetist performed on
average 100 ISB per year (personal logbooks). We demonstrate a statistically significant reduction in the dose of bupivacaine required over time.
There was additionally a trend towards improved block success rate and enhanced duration of analgesia, though these failed to reach statistical
significance.

References (Maximum 5)
1. Singh A, Kelly C, OBrien T, et al. Ultrasound-guided interscalene block anesthesia for shoulder arthroscopy. Journal of Bone & Joint Surgery
2012; 94: 2040-2046.
2. Sites BD, Chan VW, Neal JM, et al. The American Society of Regional Anesthesia and Pain Medicine Joint Committee recommendations for
education and training in ultrasound-guided regional anesthesia. Regional Anesthesia & Pain Medicine 2010; 35:S74S80.
3. Orebaugh SL, Williams BA, Kentor ML, et al. Interscalene block using ultrasound guidance: Impact of experience on resident performance. Acta
Anaesthesiologica Scandinavica 2009; 53:12681274.
4. Abrahams MS, Aziz MF, Fu RF, et al. Ultrasound-guidance compared with electrical neurostimulation for peripheral nerve block: A systematic
 15thAnnualPainMedicineMeeting
Thursday,November17,2016Saturday,November19,2016
SanDiegoCA

review and meta-analysis of randomized controlled trials. British Journal of Anaesthesia 2009; 102:408417.
5. Rosenblatt MA, Fishkind D. Proficiency in interscalene anesthesia-how many blocks are necessary? Journal of Clinical Anesthesia 2003; 15:285
288.

Tables/images

Table 1 Block Success

Table 2 Bupivicaine Dose

Table 3 Block Duration

Disclosures
I declare that there are no conflicts of interest or support that may cause bias in my presentation.