Shoulder Surgeons' Perceptions of Interscalene Nerve Blocks and a Review of Complications Rates in the Literature

Abstract

Background: Interscalene nerve blocks (ISBs) have been shown to be an effective option for regional anesthesia in shoulder surgery. Our study presents survey results of shoulder surgeons' perceptions of ISBs and a literature summary of complications rates with ISB use. Methods: A survey addressing demographics, preferences, treatment patterns, risks/benefits, and patient recommendations regarding the use of ISBs was created. Respondents were also asked whether they would elect an ISB if personally undergoing shoulder surgery, and results of other questions were stratified based on this personal preference. The survey was administered electronically to all members of the American Shoulder and Elbow Surgeons. A literature review of ISB-related complication rates was compiled from 13 studies of shoulder surgery using ISB. Results: Of all respondents, 58.7% would elect a single-shot ISB, 15.0% would elect a continuous catheter, and 26.3% would not elect the use of an ISB if undergoing shoulder surgery. Respondents from a university hospital were 1.44 times more likely to elect any ISB than respondents from a non-university hospital. Improved post-operative pain control was considered the greatest benefit, whereas persistent neuropathy was considered the greatest risk of ISB use. Of the respondents, 76.1% would recommend use of ISB to their patients undergoing shoulder surgery. Our literature review yielded 13 applicable studies that utilized a total of 6243 ISBs, with data resulting in a 0.35% major complication rate and an 11.32% minor complication rate in patients. Conclusion: The majority of shoulder surgeons surveyed in our study would elect to have a single-shot interscalene nerve block if undergoing shoulder surgery themselves, indicating that ISB use is considered a safe and effective anesthetic option among shoulder surgeon specialists.

Keywords:

• peripheral nerve block
• interscalene nerve block
• perineural catheter
• survey
• surgeon opinion