Interscalene Block

40 y/o male, 172cm, 75kg.
R't clavicle re-fracture, for revision ORIF.
Interscalene Block was performed using nerve stimulator.
5cm 22# needle.
Deltoid contraction was noted.
1.5% Lidocaine 40ml was injected slowly.
He felt hand numbness and muscle weakness (biceps & triceps) after injection.
Complete block was noted 10 minutes later and lasted for 3 hours.

Category:

Science & Technology

Tags:

• Anesthesia
• Interscalene
• Nerve Block
• Brachial Plexus
• 麻醉
• Clavicle Fracture

[AlanJet5]

Hmm. Much better to use the 2hz setting (not the 1hz) - needle movement is only half as far between stimuli which is much more precise. But worst of all, you inject a large volume of LA without aspirating first. One day the needle-tip will lie in a blood vessel, and you will learn first hand the meaning of local anaesthetic toxicity, and I hope your patient will survive.

[yrpeng]

You can see that I did aspirate twice in the block. By the way, the LA contained epinephrine (1:200000), I always listen to the heart beat to find if increase of heart rate happens.

[AlanJet5]

Fair enough - wasn't too obvious to me.

Forget your 1:200K epinephrine affecting the hr is as an early warning of LA toxicity. I presume you asked your patient to inform you immediately if they notice lips or tongue paraesthesiae, and aspirated gently every 5 mL.