Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec 17:17:107-115.
doi: 10.2147/LRA.S495105. eCollection 2024.

Effect of the Ultrasound-Guided Interscalene and Supraclavicular Blocks on the C4 Dermatome

Yue Qiu  1 , Chelsea Cady  1 , Bedda L Rosario  2 , Steven Orebaugh  1
Affiliations

Effect of the Ultrasound-Guided Interscalene and Supraclavicular Blocks on the C4 Dermatome

Yue Qiu et al. Local Reg Anesth. .

Abstract

Purpose: The C4 dermatome anesthesia holds significance for arthroscopic shoulder surgery. However, the reliability of achieving C4 dermatome anesthesia with the current low-dose ultrasound-guided interscalene block (ISB) and supraclavicular block (SCB) remains uncertain. This prospective, single-center study examined the effects of ultrasound-guided interscalene block (ISB) and supraclavicular block (SCB) on the C4 sensory dermatome in patients undergoing shoulder, hand, or wrist surgery.

Patients and methods: Patients undergoing outpatient shoulder, hand, or wrist surgeries received ultrasound-guided ISB (for shoulder surgeries) with 12-15 mL of 0.5% bupivacaine or ultrasound-guided SCB (for hand and wrist surgeries) with 20-24 mL of 0.5% bupivacaine. The primary objective of the study was to investigate the sensory effect on the C4 dermatome after ISB and SCB. The secondary outcomes included the sensory effect on the C5 dermatome after performing ISB and SCB, pain scores upon arrival at the post-anesthesia care unit (PACU), and the incidence of adverse effects.

Results: Sixty-one patients were recruited: 30 for ISB and 31 for SCB. C4 dermatome coverage was achieved in 53% and 29% of patients in the ISB and SCB groups, respectively (p=0.0268). Additionally, C5 dermatome coverage was achieved in 97% and 68% of patients in the ISB and SCB groups, respectively (p=0.0034). A moderate correlation coefficient (r=0.47) was observed between C4 sensory scores and postoperative pain scores.

Conclusion: Ultrasound-guided ISB successfully provided C4 coverage in 53% of cases, suggesting that performing an additional C4 block alongside ISB could be advantageous when aiming for complete surgical anesthesia. SCB may not be the primary choice for shoulder surgeries as it often fails to achieve satisfactory sensory blocks at the C4 and C5 levels.

Keywords: nerve block; regional anesthesia; shoulder surgeries; ultrasound-guided block.

Plain language summary

This study examined how the interscalene block and supraclavicular block work for numbing the C4 area in patients undergoing shoulder, hand, or wrist surgery. We found that the interscalene block provided C4 coverage in only 53% of cases, suggesting performing an additional C4 block might help achieve complete surgical anesthesia. The supraclavicular block is not the best option for shoulder surgeries because it often fails to provide adequate anesthesia at the C4 and C5 levels.

PubMed Disclaimer

Conflict of interest statement

The author(s) report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Distribution of C4 post block cumulative.
Figure 2
Figure 2
Distribution of C5 post block cumulative.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Hewson DW, Oldman M, Bedforth NM. Regional anaesthesia for shoulder surgery. BJA Educ. 2019;19(4):98–104. doi:10.1016/j.bjae.2018.12.004 - DOI - PMC - PubMed
    1. Warrender WJ, Syed UAM, Hammoud S, et al. Pain management after outpatient shoulder arthroscopy: a systematic review of randomized controlled trials. Am J Sports Med. 2017;45(7):1676–1686. doi:10.1177/0363546516667906 - DOI - PubMed
    1. Xiao M, Cohen SA, Cheung EV, Freehill MT, Abrams GD. Pain management in shoulder arthroplasty: a systematic review and network meta-analysis of randomized controlled trials. J Shoulder Elbow Surg. 2021;30(11):2638–2647. doi:10.1016/j.jse.2021.06.008 - DOI - PubMed
    1. Renes SH, Rettig HC, Gielen MJ, Wilder-Smith OH, van Geffen GJ. Ultrasound-guided low-dose interscalene brachial plexus block reduces the incidence of hemidiaphragmatic paresis. Reg Anesth Pain Med. 2009;34(5):498–502. doi:10.1097/AAP.0b013e3181b49256 - DOI - PubMed
    1. Hussain N, Costache I, Kumar N, et al. Is supraclavicular block as good as interscalene block for acute pain control following shoulder surgery? A systematic review and meta-analysis. Anesth Analg. 2020;130(5):1304–1319. doi:10.1213/ANE.0000000000004692 - DOI - PubMed

LinkOut - more resources