Newly Published
Editorial Views  |   September 2019
Aiming to Refine the Interscalene Block: Another Bullseye or Missing the Mark?
Author Notes
  • From the Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania (N.M.E.); Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California (E.R.M.); Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (E.R.M.).
  • Accepted for publication August 14, 2019.
    Accepted for publication August 14, 2019.×
  • Correspondence: Address correspondence to Dr. Elkassabany: Nabil.Elkassabany@pennmedicine.upenn.edu
Article Information
Editorial Views / Regional Anesthesia
Editorial Views   |   September 2019
Aiming to Refine the Interscalene Block: Another Bullseye or Missing the Mark?
Anesthesiology Newly Published on September 18, 2019. doi:10.1097/ALN.0000000000002985
Anesthesiology Newly Published on September 18, 2019. doi:10.1097/ALN.0000000000002985
In this issue of Anesthesiology, Kang et al.1  present the results of a randomized clinical trial in arthroscopic shoulder surgery patients which compares interscalene brachial plexus block with a more selective superior trunk block. The authors conclude that a superior trunk block results in noninferior analgesia and a lower risk of hemidiaphragmatic paresis (76%) when compared with interscalene block (98%). According to the authors, the superior trunk block represents “a refinement of the conventional interscalene block technique.”1  This begs the question: Why does the interscalene block need to be refined?
One way to address this question is to use a quality improvement model.2  One such model asks: (1) What are we trying to accomplish?; (2) How will we know that a change is an improvement?; and (3) What change can we make that will result in an improvement? Underlying all improvement models is general acceptance of the following concept: all improvement requires change, but not all change represents improvement.2