Der Anaesthesist
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The interscalene brachial plexus block with and without a catheter has become an indispensable method for anaesthesia and analgesia in shoulder surgery. Not only thorough knowledge of anatomy, but also accurate indication assessment and discussion with the surgeon regarding the location of access, is essential for the successful practice of this technique. Important and practical tips for implementation should especially help the less experienced, with special emphasis on correct positioning of the patient for surgery to avoid iatrogenic neural damage. Preoperative counselling of inevitable side-effects of the technique enhances the patient's acceptance and satisfaction.
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General anaesthesia and peripheral neuronal blockade are techniques which were introduced into clinical practice at the same time. Although general anaesthesia was accepted significantly faster due to effective new drugs and apparent ease of handling, neuronal blockade has recently gained great importance. The reasons are in particular newer aids such as industrially produced catheter sets, nerve stimulators and ultrasound guidance which have facilitated that these economical techniques can be used not only for intraoperative anaesthesia but also for perioperative analgesia without any major risks for the patients. ⋯ By using low concentrations of these potent drugs even for a longer period of time, no toxic plasma levels are seen with the exception of artificial intravasal injections. Additives such as opioids and alpha 2-sympathomimetics are also used. While the use of opioids is controversial, alpha 2-sympathomimetics are able to accelerate the onset and to extend the duration of regional anaesthesia and analgesia.