Name: AccessAnesthesiology - Ultrasound-Guided Interscalene Block

Description: AccessAnesthesiology - Ultrasound-Guided Interscalene Block

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Upload Date: 2022-02-27T00:00:00.0000000

Transcript: Language: EN.
Segment:0 .

MUSIC PLAYING: Ultrasound Guided Interscalene Brachial Plexus Block--
Segment:1 Anatomy.
MUSIC PLAYING: let's start off with the essential anatomy. Brachial plexus is sandwiched between the anterior and middle scalene muscles. It's important to recognize that the brachial plexus is located laterally and superficially to the carotid artery and internal jugular vein.
MUSIC PLAYING: There are many vascular structures in the vicinity of the brachial plexus. For instance, the proximity of the vertebral artery must be appreciated to avoid injury and decrease the risk of local anesthetic toxicity. This is the corresponding ultrasound image of the cross sectional anatomy shown of the Brachial Plexus. This plexus is shown sandwiched between the anterior and middle scalene muscles.
MUSIC PLAYING: It's important to keep in mind that the prevertebral fascia must be breached by the needle to allow local anesthetic to be placed in the interscalene groove.
Segment:2 Technique.
MUSIC PLAYING: The technique starts with sterile preparation of the skin.
MUSIC PLAYING: Many clinicians administer a local anesthetic to the subcutaneous skin to decrease the discomfort of the needle placement. However, it is very important not to place the needle too deep during this procedure, because the placement of a small gauge needle can easily result in an intraneural injection.
MUSIC PLAYING: The needle is placed from the lateral side toward the medial side. However, this can be reversed if the anatomy requires such. In this image, the needle is shown transversing the prevertebral fascia and the middle scalene muscle and entering the space between the middle and anterior scalene muscle. This is often accompanied by a motor response.
MUSIC PLAYING: However, motor response may not always occur. When motor response occurs at a current of 0.5 milliamps or less, than the needle is in the immediate vicinity of the brachial plexus. In this case, the current intensity is decreased until the motor response disappears to assure that motor response isn't present at 0.3 milliamps or less, which may indicate an intraneural needle placement. The injection begins first by ensuring negative aspiration.
MUSIC PLAYING: The injection is initiated making sure that the resistance to the injection isn't greater than 15 PSI. In this particular image, the needle tip is seen in the vicinity of the brachial plexus, between the middle and anterior scalene muscles. The distribution of the local anesthetic is seen within the interscalene space. Typically, this block requires between 15 and 25 ml to assure fast and reliable onset of anesthesia.
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