Interscalene Block

Joseph C. Hung, M.D.
Chief Resident

Dawn Yan, M.D.
Resident

Christopher Wu, M.D.
Professor

Department of Anesthesiology and Critical Care
Johns Hopkins University School of Medicine
Baltimore, MD

Introduction - TOP

The first case of documented brachial plexus anesthesia was performed at Johns Hopkins Hospital by a surgeon, not an anesthesiologist.  In 1884, Dr. William Stewart Halsted first injected the brachial plexus under direct vision.1  This occurred in the same year that Carl Koller first described the use of cocaine as a local anesthetic.  However, it was not until 1911 that the first percutaneous approach (axillary sheath injection) was performed by Hirschel.2  His technique was further refined by Mully, who in 1919 developed the interscalene approach to brachial plexus block in order to avoid pneumothorax.4

Regional anesthetic techniques (without general anesthesia) are effective for patients in whom oral instrumentation and/or endotracheal intubation is undesired. The patient with the difficult airway, with poor dentition, with uncertain NPO status, and/or existing morbidities (rheumatoid arthritis) is a classic example.1,2  Patient selection is key, as it is important to make sure that little or no sedation is tolerated. 

However, it is necessary to realize that the use of regional anesthesia does not preclude the use of subsequent general anesthesia.  For any case, the anesthesia practitioner must be equipped and prepared for general anesthesia.  

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