title: Low interscalene block provides reliable anesthesia for surgery at or about the elbow.
abstract: OBJECTIVE
  To determine whether interscalene brachial plexus block (ISB) provides adequate anesthesia for surgery on or about the elbow.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Operating room of an academic teaching hospital.
  
  
  METHODS
  78 patients scheduled for elective elbow surgery.
  
  
  METHODS
  All patients received an ISB using a low approach technique. A stimulating needle was inserted in the interscalene groove two cm above the clavicle. A volume of 35-45 mL of mepivacaine 1.5% or ropivacaine 0.5% was administered after obtaining a motor response of any component of the brachial plexus with a current intensity of 0.2-0.4 mA (0.1 msec).
  
  
  METHODS
  Block success rate, defined as the ability to complete surgery without use of intraoperative opioids or general anesthesia, was assessed. Verbal rating scores for pain (0 = no pain, 10 = worst pain imaginable) were obtained in the recovery room.
  
  
  RESULTS
  Low ISB resulted in successful surgical anesthesia in 75 (96%) of the study patients. Verbal rating scores were low (0-2) for all patients postoperatively.
  
  
  CONCLUSIONS
  The low interscalene block can be used to provide surgical anesthesia in the majority of patients having surgery on or about the elbow.
authors.affiliation: Department of Anesthesiology, College of Physicians & Surgeons, Columbia University, New York, NY, USA. jeffgadsden@hotmail.com
authors.forename: Jeff C
authors.initials: JC
authors.lastname: Gadsden
authors.forename: Tony
authors.initials: T
authors.lastname: Tsai
authors.forename: Takeshige
authors.initials: T
authors.lastname: Iwata
authors.forename: Lakshmanisamy
authors.initials: L
authors.lastname: Somasundarum
authors.forename: Christopher
authors.initials: C
authors.lastname: Robards
authors.forename: Admir
authors.initials: A
authors.lastname: Hadzic