Interscalene Nerve Block

What is Interscalene Nerve Block

Interscalene nerve block is an injection of numbing medicine into a group of nerves in your neck called the brachial plexus. These nerves control feeling and movement in your shoulder and upper arm. You may have this procedure to:

  • Numb your shoulder and upper arm during a surgical procedure.
  • Help relieve pain in your shoulder or upper arm after surgery.
  • Decrease the amount of anesthetic medicine you need during surgery.
  • Decrease the amount of pain medicine you need after surgery.

Compared to having general anesthetic alone, the benefits of having this procedure include:

  • Better control of pain after surgery.
  • A faster recovery with fewer side effects.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Types of surgeries and anesthetics you have had in the past.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.
  • Whether you smoke, drink alcohol, use marijuana, or use street drugs.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Damage to nerves, blood vessels, or other structures of the neck.
  • Bleeding.
  • Infection.
  • Numbness, tingling, or weakness of the shoulder or arm.
  • Numbing of other nerves near the brachial plexus. This may cause hoarseness, eye droop, lip droop, dry eye, redness in the eye, shortness of breath, or chest tightness.
  • Lung damage that causes the lung to collapse (pneumothorax).
  • Reaction to medicines, such as seizures or heart problems.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.

General instructions

  • Ask if you will be going home the same day as the procedure or the next day. If you will be able to go home soon after the procedure:
    • Plan to have someone take you home.
    • Plan to have someone stay with you for the first 24 hours after the procedure.
  • For 3–6 weeks before the procedure, try not to use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes.
  • You may brush your teeth on the morning of the procedure, but make sure to spit out the toothpaste.

What happens during the procedure?

  • To reduce your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be cleaned with soap.
  • An IV tube will be placed into one of your veins, probably in the arm that is not on the same side as the block.
  • You will be given one or more of the following medicines:
    • A medicine to help you relax (sedative).
    • A medicine to make you fall asleep (general anesthetic).
    • A medicine to help decrease pain (analgesic).
  • You will be asked to rest on your back, usually with your head turned slightly to the side.
  • Your health care provider will feel your neck above your collarbone to locate the muscles over your brachial plexus.
  • A medicine will be injected in the skin of your neck to numb the skin where the block will be placed (local anesthetic).
  • A longer needle will be inserted through your skin toward the brachial plexus.
  • Ultrasound imaging will be used to help locate your brachial plexus.
  • A needle with an electrical current may be used to stimulate and identify the correct nerves. This may cause the muscles in your shoulder or arm to twitch.
  • The numbing medicine for the brachial plexus will be injected.
  • The needle will be removed.
  • If you have a continuous block, a thin, flexible tube (catheter) may be left in place to deliver medicine to the nerves continuously, often for 1–2 days.
  • A clear bandage (dressing) may be placed over the needle puncture site.
  • If you have a continuous block, additional dressings may be added to secure the tubing.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

After the block is placed, you will be monitored and the effect of the block will be checked. Your shoulder and upper arm should be numb, and your fingers may also feel numb and tingle.

If you have a surgical procedure right after you have the block, these things may happen after the surgical procedure is complete:

  • You will be monitored closely in the recovery area.
  • Your arm may remain numb several hours afterward. If you have a continuous block catheter in place, your arm may remain numb for longer. It is important to keep your arm safe from injury while it is numb. You may have to wear a sling to protect your arm.
  • As the nerve block medicine wears off:
    • You may begin to feel pain at the surgical site. If this happens, follow instructions from your health care provider about taking other pain medicine.
    • You may experience tingling in your arm and hand.
    • You will regain strength in your muscles.
  • Do not drive for 24 hours if you were given a sedative.

Summary

  • An interscalene nerve block is an injection of numbing medicine into a group of nerves in your neck that control your shoulder and upper arm.
  • Compared to having general anesthetic alone, the benefits of having this procedure include better control of pain after surgery and a faster recovery with fewer side effects.
  • Your arm may remain numb several hours afterward. If you have a continuous block catheter in place, your arm may remain numb for longer. It is important to keep your arm safe from injury while it is numb. You may have to wear a sling to protect your arm.
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