Upper extremity blocks

Question 1

Which nerves are blocked >90% in the Interscalene Block, and which ones are blocked less than 50%?

Answer 1

C3-C7 90%

C8-T1 <50%

Question 2

Name the 3 indications for interscalene Block. What is this Block NOT recommended for?

Answer 2

1. Surgery on the shoulder, clavicle or humerus
2. Surgery on the elbow
3. Closed reduction of dislocates shoulder
   NOT recommended for hand or wrist surgery

Question 3

Contraindications to IS Block?

Answer 3

Severe lung disease
Coagulopathy
Infection at site of injection
Patient refusal/personality disorder

Question 4

Complications of IS Block (lots)

Answer 4

100% incidence of ipsilaterap hemidiaphragm paralysis

• horner’s syndrome
• Total Spinal
• LAST
• Intravascular injection

Question 5

Steps of IS Block

Answer 5

With the patient in the proper position, the skin is disinfected and the transducer is positioned in the transverse plane to identify the carotid artery. Once the artery is identified, the transducer is moved slightly laterally across the neck. The goal is to identify the scalene muscles and the brachial plexus that is sandwiched between the anterior and middle scalene muscles