SlideShare a Scribd company logo
1 of 40
Download to read offline
Shoulder block
D.mohamed mostafa Radwan
1
Introduction
Types of surgical procedures:
1-hemiarthroplasty
2-total shoulder
arthroplasty,
3- shoulder arthroscopy,
4-subacromial decompression,
5-shoulder instability procedures
such as rotator cuff repair.
2
Type of the Patient :
fit, robust patient with a
sports injury requiring a
stabilization procedure, to the
frail, elderly rheumatoid patient
requiring joint decompression
or arthroplasty.
3
Do we Need regional
anesthesia ??
Shoulder surgery is associated
with significant postoperative
pain, but mobilization and
physiotherapy often begin on
the first postoperative day.
4
regional nerve block
intra-articular analgesia with or
without continuous infusion
local anaesthetic wound infiltration
conventional oral and parenteral
analgesia;
5
Anatomy of the
shoulder
9
10
Innervation of the
shoulder
• Cervical plexus
• Brachial plexus
13
14
15
Suprascapular and Axillary
nerve block ......enough ??!!
17
18
19
Residual pain?!
Indications
• Preoperative :conditions where interscalene
block is contraindicated, open and
arthroscopic shoulder procedures .....rotator
cuff surgery ???!!.
• Postoperative : interscalene failure, catheter
displacement ....
20
Suprascapular nerve block
"technique of Meier"
The technique chosen was that
described by Meier, which allows
blockade of the suprascapular
nerve during its passage from the
suprascapular notch to the
spinoglenoid notch
21
24
25
Axillary nerve block
"technique of Price"
The safest and most consistent point at which
to block the axillary nerve is immediately
following this nerve’s passage through the
quadrilateral space to lie on the posterior
surface of the humerus.
30
36
If no twitches are elicited on first pass, the
needle tip should be walked up and down the
posterior surface the humerus, If twitches are
still not elicited, 10 to 15ml of LA can be
deposited beneath the deltoid on the posterior
surface of the humerus at the initial entry point.
37
Supplemental
analgesia requirement
• routine supplemental small doses of opioids
or paracetamol could be a good adjuvant to
ur block.
• Day Case surgery........
38
Summary
The evidence indicates that the
suprascapular and/or axillary nerve
blocks are not as effective as an
interscalene block. However in patients
who are not candidates for the
interscalene block, these blocks may
provide a useful alternative for short-
term pain relief.
39
Thanks for attention

More Related Content

What's hot

Posterior Spine Fixation
Posterior Spine FixationPosterior Spine Fixation
Posterior Spine Fixation
Ghazwan Bayaty
 
Retroperitoneal approach to the lumbar spine1
Retroperitoneal approach to the lumbar spine1Retroperitoneal approach to the lumbar spine1
Retroperitoneal approach to the lumbar spine1
Nitin Paikrao
 

What's hot (20)

Femur supracondylar fractures
Femur supracondylar fracturesFemur supracondylar fractures
Femur supracondylar fractures
 
Posterior Spine Fixation
Posterior Spine FixationPosterior Spine Fixation
Posterior Spine Fixation
 
Retroperitoneal approach to the lumbar spine1
Retroperitoneal approach to the lumbar spine1Retroperitoneal approach to the lumbar spine1
Retroperitoneal approach to the lumbar spine1
 
Fracture neck of femur puri
Fracture neck of femur   puriFracture neck of femur   puri
Fracture neck of femur puri
 
Surgical Approaches to distal humerus fractures - DR.S.SENTHIL SAILESH, M.S...
 Surgical Approaches to distal  humerus fractures - DR.S.SENTHIL SAILESH, M.S... Surgical Approaches to distal  humerus fractures - DR.S.SENTHIL SAILESH, M.S...
Surgical Approaches to distal humerus fractures - DR.S.SENTHIL SAILESH, M.S...
 
Medical management of Spinal Cord Injuries
Medical management of Spinal Cord InjuriesMedical management of Spinal Cord Injuries
Medical management of Spinal Cord Injuries
 
fracture of neck of femur
fracture of neck of femurfracture of neck of femur
fracture of neck of femur
 
Distal humerus fractures
Distal humerus fracturesDistal humerus fractures
Distal humerus fractures
 
Fusion techniques spine
Fusion techniques spineFusion techniques spine
Fusion techniques spine
 
Elbow dislocations and terrible triad
Elbow dislocations and terrible triadElbow dislocations and terrible triad
Elbow dislocations and terrible triad
 
Surgical approach intercondylar/ supracondylar humerus fracture
Surgical approach intercondylar/ supracondylar humerus fractureSurgical approach intercondylar/ supracondylar humerus fracture
Surgical approach intercondylar/ supracondylar humerus fracture
 
Forearm fractures
Forearm fracturesForearm fractures
Forearm fractures
 
Distal humerus fracture
Distal humerus fractureDistal humerus fracture
Distal humerus fracture
 
pedicle screw insertion
pedicle screw insertionpedicle screw insertion
pedicle screw insertion
 
Anatomy of elbow and INTERCONDYLAR FRACTURE OF THE HUMERUS
Anatomy of elbow and INTERCONDYLAR FRACTURE OF THE HUMERUSAnatomy of elbow and INTERCONDYLAR FRACTURE OF THE HUMERUS
Anatomy of elbow and INTERCONDYLAR FRACTURE OF THE HUMERUS
 
Cervical spine
Cervical spineCervical spine
Cervical spine
 
Thoraco lumbar fractures of spine
Thoraco lumbar fractures of spine Thoraco lumbar fractures of spine
Thoraco lumbar fractures of spine
 
Spinal Cord Injury
Spinal Cord InjurySpinal Cord Injury
Spinal Cord Injury
 
femoral shaft fracture
femoral shaft fracturefemoral shaft fracture
femoral shaft fracture
 
distal femur fracture
distal femur fracturedistal femur fracture
distal femur fracture
 

Similar to Shoulder block tutorial 2014

Shoulder impingement syndrome
Shoulder impingement syndromeShoulder impingement syndrome
Shoulder impingement syndrome
Tafzz Sailo
 
Anaesthesia for THR & TKR
Anaesthesia for THR & TKRAnaesthesia for THR & TKR
Anaesthesia for THR & TKR
Aftab Hussain
 

Similar to Shoulder block tutorial 2014 (20)

SHOULDER SPORT INJURIES
SHOULDER SPORT INJURIES SHOULDER SPORT INJURIES
SHOULDER SPORT INJURIES
 
dislocations & fractures of Elbow in adults
dislocations & fractures of Elbow in adultsdislocations & fractures of Elbow in adults
dislocations & fractures of Elbow in adults
 
hernia& appendictomy basicas of rehab.pptx
hernia& appendictomy basicas  of rehab.pptxhernia& appendictomy basicas  of rehab.pptx
hernia& appendictomy basicas of rehab.pptx
 
Midshaft femur fracture
Midshaft femur fractureMidshaft femur fracture
Midshaft femur fracture
 
Spinal Cord Injury 3
Spinal Cord Injury 3Spinal Cord Injury 3
Spinal Cord Injury 3
 
GENERAL PRINCIPLES OF CLOSED AND OPEN FRACTURES
GENERAL PRINCIPLES OF CLOSED AND OPEN FRACTURESGENERAL PRINCIPLES OF CLOSED AND OPEN FRACTURES
GENERAL PRINCIPLES OF CLOSED AND OPEN FRACTURES
 
Distal humerus.
Distal humerus.Distal humerus.
Distal humerus.
 
Orthopedics 2
Orthopedics 2Orthopedics 2
Orthopedics 2
 
Radial head and neck fractures
Radial head and neck fracturesRadial head and neck fractures
Radial head and neck fractures
 
Shoulder impingement syndrome
Shoulder impingement syndromeShoulder impingement syndrome
Shoulder impingement syndrome
 
Anaesthesia for THR & TKR
Anaesthesia for THR & TKRAnaesthesia for THR & TKR
Anaesthesia for THR & TKR
 
Ligamentous injury around knee joint
Ligamentous injury around knee jointLigamentous injury around knee joint
Ligamentous injury around knee joint
 
Arthroscopic pcl reconstruction
Arthroscopic pcl reconstructionArthroscopic pcl reconstruction
Arthroscopic pcl reconstruction
 
frozen shoulder by usman
frozen shoulder by usmanfrozen shoulder by usman
frozen shoulder by usman
 
Knee soft tissue postgraduate orthopaedic 2016
Knee soft tissue postgraduate orthopaedic 2016Knee soft tissue postgraduate orthopaedic 2016
Knee soft tissue postgraduate orthopaedic 2016
 
Postoperative care of femoral shaft and supracondylar fx
Postoperative care of femoral shaft and supracondylar fxPostoperative care of femoral shaft and supracondylar fx
Postoperative care of femoral shaft and supracondylar fx
 
Cervical spine fractures dnbid 2020
Cervical spine fractures dnbid 2020Cervical spine fractures dnbid 2020
Cervical spine fractures dnbid 2020
 
Management of Shoulder dislocations and shoulder instability in sports
Management of Shoulder dislocations and shoulder instability in sports Management of Shoulder dislocations and shoulder instability in sports
Management of Shoulder dislocations and shoulder instability in sports
 
Brachial Plexus Injuries.pptx
Brachial Plexus Injuries.pptxBrachial Plexus Injuries.pptx
Brachial Plexus Injuries.pptx
 
Management of paediatric supracondlar humeral fractures
Management of paediatric supracondlar humeral fracturesManagement of paediatric supracondlar humeral fractures
Management of paediatric supracondlar humeral fractures
 

More from mohamed mohamed

Sources of exposure to chlorhexidine in the health care setting
Sources of exposure to chlorhexidine in the health care settingSources of exposure to chlorhexidine in the health care setting
Sources of exposure to chlorhexidine in the health care setting
mohamed mohamed
 
Regional anaesthesia for tkr presentation for orthopaedic meeting
Regional anaesthesia for tkr presentation for orthopaedic meetingRegional anaesthesia for tkr presentation for orthopaedic meeting
Regional anaesthesia for tkr presentation for orthopaedic meeting
mohamed mohamed
 
Neuroaxial ultrasound tutorial in cumbria ultrasound course 2018
Neuroaxial ultrasound tutorial in cumbria ultrasound course 2018Neuroaxial ultrasound tutorial in cumbria ultrasound course 2018
Neuroaxial ultrasound tutorial in cumbria ultrasound course 2018
mohamed mohamed
 

More from mohamed mohamed (20)

Vascular access tutorial for fy2
Vascular access  tutorial for fy2 Vascular access  tutorial for fy2
Vascular access tutorial for fy2
 
Trauma lists
Trauma listsTrauma lists
Trauma lists
 
Transfusion reactions tutorial 2010
Transfusion reactions tutorial 2010Transfusion reactions tutorial 2010
Transfusion reactions tutorial 2010
 
Timing of fracture femur fixation audit 2016
Timing of fracture femur fixation audit 2016Timing of fracture femur fixation audit 2016
Timing of fracture femur fixation audit 2016
 
Tracheal extubation lecture
Tracheal extubation lectureTracheal extubation lecture
Tracheal extubation lecture
 
Thrive tutorial for depatement 2019
Thrive tutorial for depatement 2019Thrive tutorial for depatement 2019
Thrive tutorial for depatement 2019
 
Sources of exposure to chlorhexidine in the health care setting
Sources of exposure to chlorhexidine in the health care settingSources of exposure to chlorhexidine in the health care setting
Sources of exposure to chlorhexidine in the health care setting
 
Spectral entropy 2012
Spectral entropy 2012Spectral entropy 2012
Spectral entropy 2012
 
Regional anaesthesia for tkr presentation for orthopaedic meeting
Regional anaesthesia for tkr presentation for orthopaedic meetingRegional anaesthesia for tkr presentation for orthopaedic meeting
Regional anaesthesia for tkr presentation for orthopaedic meeting
 
Preoperative cardiacassessment
Preoperative cardiacassessmentPreoperative cardiacassessment
Preoperative cardiacassessment
 
Saline vs air
Saline vs airSaline vs air
Saline vs air
 
Orphan diseases anaethesia tutorial for trainees 2015
Orphan diseases anaethesia tutorial for trainees 2015Orphan diseases anaethesia tutorial for trainees 2015
Orphan diseases anaethesia tutorial for trainees 2015
 
Neuroaxial ultrasound tutorial in cumbria ultrasound course 2018
Neuroaxial ultrasound tutorial in cumbria ultrasound course 2018Neuroaxial ultrasound tutorial in cumbria ultrasound course 2018
Neuroaxial ultrasound tutorial in cumbria ultrasound course 2018
 
Gastric ultrasound tutorial 2019
Gastric ultrasound tutorial 2019Gastric ultrasound tutorial 2019
Gastric ultrasound tutorial 2019
 
Fascia ileaca block
Fascia ileaca blockFascia ileaca block
Fascia ileaca block
 
Erector spinae block 2
Erector spinae block 2Erector spinae block 2
Erector spinae block 2
 
Critical incidents scinarios for trainees
Critical incidents scinarios for trainees Critical incidents scinarios for trainees
Critical incidents scinarios for trainees
 
Anaethetic management of scoliotic patients
Anaethetic management of scoliotic patientsAnaethetic management of scoliotic patients
Anaethetic management of scoliotic patients
 
Eclmpasia m&m case presentation 2018
Eclmpasia  m&m case presentation 2018Eclmpasia  m&m case presentation 2018
Eclmpasia m&m case presentation 2018
 
Neck breathers presentation for trainees 2014
Neck breathers presentation for trainees 2014Neck breathers presentation for trainees 2014
Neck breathers presentation for trainees 2014
 

Recently uploaded

ASSISTING WITH THE USE OF URINAL BY ANUSHRI SRIVASTAVA.pptx
ASSISTING WITH THE USE OF URINAL BY ANUSHRI SRIVASTAVA.pptxASSISTING WITH THE USE OF URINAL BY ANUSHRI SRIVASTAVA.pptx
ASSISTING WITH THE USE OF URINAL BY ANUSHRI SRIVASTAVA.pptx
AnushriSrivastav
 
Cell structure slideshare.pptx Unlocking the Secrets of Cells: Structure, Fun...
Cell structure slideshare.pptx Unlocking the Secrets of Cells: Structure, Fun...Cell structure slideshare.pptx Unlocking the Secrets of Cells: Structure, Fun...
Cell structure slideshare.pptx Unlocking the Secrets of Cells: Structure, Fun...
ananyagirishbabu1
 
Benefits of Dentulu's Salivary Testing.pptx
Benefits of Dentulu's Salivary Testing.pptxBenefits of Dentulu's Salivary Testing.pptx
Benefits of Dentulu's Salivary Testing.pptx
Dentulu Inc
 

Recently uploaded (20)

Management of heart failure 23.02.24.pptx
Management of heart failure 23.02.24.pptxManagement of heart failure 23.02.24.pptx
Management of heart failure 23.02.24.pptx
 
CHAPTER- 1 NATIONAL-POLICIES-AND-LEGISLATION.pdf
CHAPTER- 1 NATIONAL-POLICIES-AND-LEGISLATION.pdfCHAPTER- 1 NATIONAL-POLICIES-AND-LEGISLATION.pdf
CHAPTER- 1 NATIONAL-POLICIES-AND-LEGISLATION.pdf
 
2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdf
2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdf2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdf
2024 03 Monumental Mistakes in EMS BAD EMS v0.2.pdf
 
Boost Your Brain: Discover Natural Herbal Memory Supplements for Enhanced Cog...
Boost Your Brain: Discover Natural Herbal Memory Supplements for Enhanced Cog...Boost Your Brain: Discover Natural Herbal Memory Supplements for Enhanced Cog...
Boost Your Brain: Discover Natural Herbal Memory Supplements for Enhanced Cog...
 
PhRMA Vaccines Deck_05-15_2024_FINAL.pptx
PhRMA Vaccines Deck_05-15_2024_FINAL.pptxPhRMA Vaccines Deck_05-15_2024_FINAL.pptx
PhRMA Vaccines Deck_05-15_2024_FINAL.pptx
 
Chris Shade BS MEd MS LPC-Associate "Presume" (What Do I Do?)
Chris Shade BS MEd MS LPC-Associate "Presume" (What Do I Do?)Chris Shade BS MEd MS LPC-Associate "Presume" (What Do I Do?)
Chris Shade BS MEd MS LPC-Associate "Presume" (What Do I Do?)
 
ASSISTING WITH THE USE OF URINAL BY ANUSHRI SRIVASTAVA.pptx
ASSISTING WITH THE USE OF URINAL BY ANUSHRI SRIVASTAVA.pptxASSISTING WITH THE USE OF URINAL BY ANUSHRI SRIVASTAVA.pptx
ASSISTING WITH THE USE OF URINAL BY ANUSHRI SRIVASTAVA.pptx
 
Cell structure slideshare.pptx Unlocking the Secrets of Cells: Structure, Fun...
Cell structure slideshare.pptx Unlocking the Secrets of Cells: Structure, Fun...Cell structure slideshare.pptx Unlocking the Secrets of Cells: Structure, Fun...
Cell structure slideshare.pptx Unlocking the Secrets of Cells: Structure, Fun...
 
Colonoscopy Screening And Age: Adapting Guidelines For Different Life Stages
Colonoscopy Screening And Age: Adapting Guidelines For Different Life StagesColonoscopy Screening And Age: Adapting Guidelines For Different Life Stages
Colonoscopy Screening And Age: Adapting Guidelines For Different Life Stages
 
Importance of Diet on Dental Health.docx
Importance of Diet on Dental Health.docxImportance of Diet on Dental Health.docx
Importance of Diet on Dental Health.docx
 
Storage_of _Bariquin_Components_in_Storage_Boxes.pptx
Storage_of _Bariquin_Components_in_Storage_Boxes.pptxStorage_of _Bariquin_Components_in_Storage_Boxes.pptx
Storage_of _Bariquin_Components_in_Storage_Boxes.pptx
 
PT MANAGEMENT OF URINARY INCONTINENCE.pptx
PT MANAGEMENT OF URINARY INCONTINENCE.pptxPT MANAGEMENT OF URINARY INCONTINENCE.pptx
PT MANAGEMENT OF URINARY INCONTINENCE.pptx
 
Sugar Medicine_ Natural Homeopathy Remedies for Blood Sugar Management.pdf
Sugar Medicine_ Natural Homeopathy Remedies for Blood Sugar Management.pdfSugar Medicine_ Natural Homeopathy Remedies for Blood Sugar Management.pdf
Sugar Medicine_ Natural Homeopathy Remedies for Blood Sugar Management.pdf
 
Master the Art of Yoga with Joga Yoga Training
Master the Art of Yoga with Joga Yoga TrainingMaster the Art of Yoga with Joga Yoga Training
Master the Art of Yoga with Joga Yoga Training
 
Renal Replacement Therapy - ICU Guidlines
Renal Replacement  Therapy - ICU GuidlinesRenal Replacement  Therapy - ICU Guidlines
Renal Replacement Therapy - ICU Guidlines
 
For Better Jaipur #ℂall #Girl Service ❤89011-83002❤ Jaipur #ℂall #Girls
For Better Jaipur #ℂall #Girl Service ❤89011-83002❤ Jaipur #ℂall #Girls For Better Jaipur #ℂall #Girl Service ❤89011-83002❤ Jaipur #ℂall #Girls
For Better Jaipur #ℂall #Girl Service ❤89011-83002❤ Jaipur #ℂall #Girls
 
Improve Patient Care with Medical Record Abstraction
Improve Patient Care with Medical Record AbstractionImprove Patient Care with Medical Record Abstraction
Improve Patient Care with Medical Record Abstraction
 
Importance-of-Protein-During-Pregnancy Time
Importance-of-Protein-During-Pregnancy TimeImportance-of-Protein-During-Pregnancy Time
Importance-of-Protein-During-Pregnancy Time
 
Breaking Down Oppositional Defiant Disorder Treatments
Breaking Down Oppositional Defiant Disorder TreatmentsBreaking Down Oppositional Defiant Disorder Treatments
Breaking Down Oppositional Defiant Disorder Treatments
 
Benefits of Dentulu's Salivary Testing.pptx
Benefits of Dentulu's Salivary Testing.pptxBenefits of Dentulu's Salivary Testing.pptx
Benefits of Dentulu's Salivary Testing.pptx
 

Shoulder block tutorial 2014

  • 2. Introduction Types of surgical procedures: 1-hemiarthroplasty 2-total shoulder arthroplasty, 3- shoulder arthroscopy, 4-subacromial decompression, 5-shoulder instability procedures such as rotator cuff repair. 2
  • 3. Type of the Patient : fit, robust patient with a sports injury requiring a stabilization procedure, to the frail, elderly rheumatoid patient requiring joint decompression or arthroplasty. 3
  • 4. Do we Need regional anesthesia ?? Shoulder surgery is associated with significant postoperative pain, but mobilization and physiotherapy often begin on the first postoperative day. 4
  • 5. regional nerve block intra-articular analgesia with or without continuous infusion local anaesthetic wound infiltration conventional oral and parenteral analgesia; 5
  • 7.
  • 8.
  • 9. 9
  • 10. 10
  • 11. Innervation of the shoulder • Cervical plexus • Brachial plexus
  • 12.
  • 13. 13
  • 14. 14
  • 15. 15
  • 16.
  • 17. Suprascapular and Axillary nerve block ......enough ??!! 17
  • 18. 18
  • 20. Indications • Preoperative :conditions where interscalene block is contraindicated, open and arthroscopic shoulder procedures .....rotator cuff surgery ???!!. • Postoperative : interscalene failure, catheter displacement .... 20
  • 21. Suprascapular nerve block "technique of Meier" The technique chosen was that described by Meier, which allows blockade of the suprascapular nerve during its passage from the suprascapular notch to the spinoglenoid notch 21
  • 22.
  • 23.
  • 24. 24
  • 25. 25
  • 26.
  • 27.
  • 28.
  • 29.
  • 30. Axillary nerve block "technique of Price" The safest and most consistent point at which to block the axillary nerve is immediately following this nerve’s passage through the quadrilateral space to lie on the posterior surface of the humerus. 30
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.
  • 36. 36
  • 37. If no twitches are elicited on first pass, the needle tip should be walked up and down the posterior surface the humerus, If twitches are still not elicited, 10 to 15ml of LA can be deposited beneath the deltoid on the posterior surface of the humerus at the initial entry point. 37
  • 38. Supplemental analgesia requirement • routine supplemental small doses of opioids or paracetamol could be a good adjuvant to ur block. • Day Case surgery........ 38
  • 39. Summary The evidence indicates that the suprascapular and/or axillary nerve blocks are not as effective as an interscalene block. However in patients who are not candidates for the interscalene block, these blocks may provide a useful alternative for short- term pain relief. 39