[Interscalene plexus block for mobilizing chronic shoulder stiffness].
BACKGROUND
After mobilisation of a frozen shoulder, patients should work with a physiotherapist one to two times a day. In the remaining time patients must exercise on their own: otherwise, the shoulder is likely to become less mobile. Exercise is only possible in the absence of pain. Therefore, adequate analgesic therapy for four to five days after the first mobilisation is of great importance. We used interscalene blockade of the brachial plexus to achieve mobilisation in patients suffering from a painful frozen shoulder. We investigated the efficacy of this technique by registering the use of additional analgesics and documenting the patient's assessment. The observation time was 18 months.


METHODS
Thirty-seven patients were treated with a plexus block using a catheter inserted at the affected side. Catheter location was verified with electric nerve stimulation. In all patients a bolus of 20 ml bupivacaine 0.375% was given for initial mobilisation, followed by 10 ml bupivacaine 0.25% every 6 hours.


RESULTS
In 34 of 37 (92%) patients, the shoulder could be mobilised without general anaesthesia. Thirty-three of 37 (89%) patients did not need any additional analgesics during the following mobilizations. The mean duration of catheter treatment was 4 days; no infections occurred. The following side effects were observed at the first mobilisation: Horner's syndrome in 20 patients (54%), paresis of the recurrent nerve in 9 patients (24%) and paresis of the phrenic nerve in 6 patients (16%). During subsequent treatment, Horner's syndrome was observed in 15 patients (41%) and a paresis of the recurrent nerve in 8 patients (22%). In an interview after the end of the treatment period all patients stated that they would use this method again if necessary.


CONCLUSIONS
With the use of this regional anaesthesia technique it was possible to provide comfortable pain therapy during the mobilisation period. In order to achieve sufficient analgesia with only a mild motor blockade of the motoneurons, the exact location of the catheter tip is important. The latter can be verified by electrical stimulation.
Lierz
P
P
Abteilung für Allgemeine Anästhesie und Intensivmedizin B, Universität Wien, Osterreich. peter.lierz@univie.ac.at
Hoffmann
P
P
Felleiter
P
P
Hörauf
K
K
D000328:Adult; D000368:Aged; D001917:Brachial Plexus / Q000187:drug effects*; D002045:Bupivacaine; D005260:Female; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement; D010489:Periarthritis / Q000534:rehabilitation*; D019534:Shoulder Impingement Syndrome / Q000534:rehabilitation*; D016896:Treatment Outcome
D002045:Bupivacaine
Die interskalenäre Plexus-Blockade zur Mobilisation bei chronischer Schultersteife.