الفهرس 
ANATOMICAL CONSIDERATIONSOnly 14 pages are availabe for public view
 |  | from | 132 |  |  |
| | | from | 132 | | |
Abstract
Regional anesthesia has been greatly developed especially in the past two decades, it can reduce or avoid the hazards of general anesthesia, and it also offers a number of advantages to outpatients undergoing surgery.
Arthroscopic shoulder surgery has a 45% incidence of severe intraoperative and postoperative pain that is often significant enough to interfere with initial recovery and rehabilitation
Ways to control postoperative pain include opiate analgesics, IA injections of morphine or local anesthetics, and nerve blocks.
Uncontrolled postoperative pain has an adverse sequel of delayed resumption of normal pulmonary function, nausea and vomiting, increase in the systemic vascular resistance and myocardial oxygen consumption through an increase in the catecholamine release induced by the stress response.
Brachial plexus blocks which are frequently used for patients needing upper extremity surgery.
The use of regional anesthesia, in the form of interscalene brachial plexus blockade, is gaining popularity because of the numerous benefits that have been attributed to this type of anesthesia, because shoulder surgery frequently results in severe postoperative pain, the preemptive and intense intraoperative analgesia provided by interscalene blockade. But it is associated with some side effects and complications.
The terminal branches of the suprascapular nerve and the axillary nerve (brachial plexus), in addition to other small sensitive branches originating from the cervical plexus, are responsible for the sensitive innervation of the shoulder. By blocking the two main nerves (suprascapular nerve and axillary nerve) that supply sensory innervation of the shoulder, we would ensure safe and effective anesthesia for most arthroscopic shoulder surgeries.
The current clinical study was designed to compare between interscalene block and combined suprascapular nerve and axillary nerve blocks in arthroscopic shoulder surgery as regard intraoperative anesthesia and postoperative analgesia.
Our study was performed on 60 adult patients of ASA I and II undergoing arthroscopic shoulder surgery.
Group A (30 patients) interscalene block, 30 ml of a mixture of 10 ml lidocaine 2% and 20 ml bupivacaine 0.5% were injected.
Group B (30 patients) combined suprascapular and axillary nerve blocks.
Suprascapular nerve block, 15 ml of a mixture of 5 ml lidocaine 2% and 10 ml bupivacaine 0.5% were injected.
Axillary nerve block 15 ml of the same mixture was injected.
The two anesthetic were compared regarding the following parameters, onset of sensory and motor blocks, degree of motor block be assessed by Bromage scale
During the surgical procedure, the following parameters will be recorded: of anesthesia (need for intraoperative analgesia). `
Postoperative pain was assessed using Visual Analogue Scale (VAS), the requirement of postoperative analgesics, occurrence of complications and patient satisfactions were recorded.
Onset of sensory and motor blocks was earlier in interscalene group.
As regard the need of intraoperative analgesia it was higher in combined suprascapular and axillary nerve blocks group.
In postoperative period there was no statistically difference between the two groups as regard VAS and analgesics requirement.
Complications were recorded in interscalene group as Horner’ S, hoarseness of voice, major weakness of upper arm and dyspnea.