Les alternatives au bloc interscalénique

Interscalene block is the gold standard for postoperative analgesia after shoulder surgery. The side effects reported with this technique include pleural puncture and pneumothorax, central neuraxial needle placement, cervical cord damage, phrenic nerve anesthesia responsible for hemidiaphragmatic palsy leading to dyspnea, hoarseness, bradycardia and hypotension. Interscalene block is contraindicated in patients presenting with a reduction in pulmonary function. Alternative techniques to interscalene block include lower doses of local anesthetic, supraclavicular block, suprascapular block ± axillary block (called 'shoulder block') and indwelling infusion catheters. The suprascapular ± axillary block ('shoulder block') represents an attractive alternative. The supraclavicular block exhibits the same limits as the interscalene block, concerning especially the risk of phrenic anesthesia. Intra-articular analgesia cannot be recommended because of a little efficacy and the risk of catastrophic glenohumeral chondrolysis.