The most appropriate next step after an incomplete interscalene block for shoulder anesthesia is to perform which block?

The most appropriate next step after an incomplete interscalene block for shoulder anesthesia is to perform which block?

• A. Repeat block
• B. Intercostobrachial block
• C. Superficial cervical plexus block
• D. Induce general anesthesia

Answer: (C)

When a shoulder block from the interscalene approach is incomplete, the remaining sensation often comes from the superficial cervical plexus, which provides cutaneous innervation to the shoulder area over the clavicle. Blocking these supraclavicular nerves with a superficial cervical plexus block complements the interscalene block and often completes anesthesia for shoulder procedures. This targeted addition addresses the skin innervation that the interscalene block may miss, without turning to a full general anesthetic. Repeating the interscalene block is unlikely to add much if the completeness issue is due to missing cervical plexus coverage. An intercostobrachial block would address the medial arm, not the shoulder/clavicle skin. Inducing general anesthesia would be more invasive when a regional salvage is available.

When a shoulder block from the interscalene approach is incomplete, the remaining sensation often comes from the superficial cervical plexus, which provides cutaneous innervation to the shoulder area over the clavicle. Blocking these supraclavicular nerves with a superficial cervical plexus block complements the interscalene block and often completes anesthesia for shoulder procedures. This targeted addition addresses the skin innervation that the interscalene block may miss, without turning to a full general anesthetic.

Repeating the interscalene block is unlikely to add much if the completeness issue is due to missing cervical plexus coverage. An intercostobrachial block would address the medial arm, not the shoulder/clavicle skin. Inducing general anesthesia would be more invasive when a regional salvage is available.