How to Perform Ultrasound-Guided Interscalene Nerve Blocks
By Arun Nagdev, MD; Graham Becherer-Bailey, DO; Rob Farrow, DO; and Daniel Mantuani, MD, MPH
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on April 14, 2020
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Conclusion
The ultrasound-guided ISNB is an ideal tool for emergency providers when treating patients with acute upper-extremity injuries. The two simple tips can help improve block success. Having an alternative technique to locate the interscalane brachial plexus and having a defined safe target (the prevertebral fascia) that is far away from the nerve roots can help circumvent problems that we notice in our learners. We hope that these small adjustments will help make the ultrasound-guided ISNB an important tool in your clinical practice and part of your multimodal strategy for pain management.
Dr. Nagdev is director of emergency ultrasound at Highland General Hospital, Alameda Health System in Oakland, California.
Dr. Becherer-Bailey and Dr. Farrow Care ultrasound fellows at Highland General Hospital.
Dr. Mantuani is ultrasound fellowship director at Highland General Hospital.
References
- Raeyat Doost E, Heiran MM, Movahedi M, et al. Ultrasound-guided interscalene nerve block vs procedural sedation by propofol and fentanyl for anterior shoulder dislocations. Am J Emerg Med. 2017;35(10):1435-1439.
- Blaivas M, Lyon M. Ultrasound-guided interscalene block for shoulder dislocation reduction in the ED. Am J Emerg Med. 2006;24(3):293-296.
- Tirado A, Nagdev A, Henningsen C, et al. Ultrasound-guided procedures in the emergency department-needle guidance and localization. Emerg Med Clin North Am. 2013;31(1):87-115.
- Beals T, Odashima K, Haines LE, et al. Interscalene brachial plexus nerve block in the emergency department: an effective and practice-changing workshop. Ultrasound J. 2019;11(1):15.
- Tsui BC, Lou L. Learning the “traceback” approach for interscalene block. Anaesthesia. 2014;69(1):83-85.
- Beh ZY, Osman A, Fathil S, et al. Ultrasound guided interscalene brachial plexus block with low dose sedation – technique of choice for reducing shoulder dislocation. Am J Emerg Med. 2018;36(4):717-718.
One Response to “How to Perform Ultrasound-Guided Interscalene Nerve Blocks”
May 6, 2020
Vir SinghExcited to implement this in my practice and share this with my residency program