The following is a summary of “Low-Volume Targeted Interscalene Brachial Plexus Block in the Emergency Department as a Safer Alternative for Pain Control for Glenohumeral Reduction: A Case Series,” published in the September 2023 issue of Emergency Medicine by Lentz, et al.

Patients often arrive at emergency departments (EDs) with acute glenohumeral dislocation. However, it may be difficult to manage their pain to enable reduction effectively. Effective analgesia may be achieved with procedural sedation or peripheral nerve blocks; however, both methods are not hazardous. Paralysis of the ipsilateral hemidiaphragm may occur if the phrenic nerve is accidentally involved during an interscalene brachial plexus block. However, the emergency physician may use strategies to lessen these dangers and maximize the interscalene brachial plexus block for conditions like glenohumeral dislocation.

Researchers describe three examples of individuals diagnosed with ED (emergent dislocation of the jaw). Two of the patients had a history of lung illness. In all three patients, targeted low-volume interscalene nerve blocks were administered and paired with systemic analgesia to promote effective closed glenohumeral reduction and limit the chance of diaphragm paralysis. After the operation, all 3 patients were observed for a while before being sent home from the ER.

The objective of the emergency clinician should be to adapt blocks for particular operations, patients, and diseases, in contrast to the purpose of the anesthesiologist, who typically seeks to achieve thick surgical blocks. A small amount (5-10 mL) of anesthetic targeted to certain nerve roots (C5 and C6) may give excellent analgesia and limit the likelihood of diaphragm involvement, allowing the emergency physician to optimize the interscalene brachial plexus block for glenohumeral dislocation.

Source: sciencedirect.com/science/article/abs/pii/S0736467923003013