Applying cervical spine anatomy to interscalene brachial plexus blocks

The interscalene brachial plexus block (ISBPB) is a most reliable and commonly performed technique for regional anesthesia of the upper extremity. It has widespread clinical applicability, ranging from use for shoulder surgery as well as diagnostic and therapeutic uses in pain management. Traditional methods described for performing the ISBPB involve identifying surface anatomy landmarks. Unfortunately, in patients with less than ideal landmarks (those with short, thick necks and those lacking adequate muscle tone in the neck area) it becomes increasingly challenging to identify these landmarks. As a result there is greater uncertainty in accurately locating the brachial plexus, and consequently greater risk in performing the block. A simple new approach to the interscalene brachial plexus block is described, utilizing the bony anatomy of the cervical spine as a landmark for directing the needle to the correct position, a nerve stimulator, and a confirmatory injection of a test dose of anesthetic solution to enhance accuracy. In addition, by correctly implementing this technique, the block may be performed by a sole operator. This simple approach has proven to be clinically effective in more than 2,000 blocks of the brachial plexus during the past 4 years. It is concluded that this technique represents a safe, reproducible, and highly successful method for use by anesthesiologists and pain physicians alike.