We are very flattered by the interest showed by Drs. Casati and Chelly in our study dealing with interscalene block and shoulder surgery. 1Drs. Casati and Chelly deplored that we did not discuss the various factors that could be responsible for the observed complications. Our title, “… Associated with Interscalene Block and  Shoulder Surgery,” expresses the aim of the study, which is to assess the incidence of minor and major complications occurring in this clinical context, and not the causal factors. Fanelli et al.  2conducted a remarkable investigation, but their results cannot be extrapolated to ours. Their methodology included different blocks, different approaches (?), different drugs with or without additives, the multiple injections technique (by the way, the supraclavicular nerve is not responsible for shoulder abduction), and different teams, and in their protocol, the complications were only one endpoint among others. On the contrary, in our study, we had a standardized procedure on all aspects, with complications being the only one endpoint. The way Fanelli et al.  2assessed complications led us to believe that the incidence of “minor complications” was underestimated in this study. We noticed that the majority of these minor complications were only revealed by an extensive interview and clinical examination done at different times by one anesthetist and one surgeon separately. For these patients, paresthesias and dysesthesias were mostly trivial as compared to the problems associated with postoperative rehabilitation.

The performance of neurophysiologic examinations (ENMG) should, of course, not be routinely done in daily practice; however, in our study, ENMG has shown that minor complications (paresthesias, dysesthesias, etc.) are not associated with ENMG abnormalities—a point which was to date not clear in the literature—and most importantly that other specific pathologies might occur, which we have to think about after this type of surgery. Finally, we agree that multicenter studies are needed; they will be a good complement to a study like the one we conducted. If we know what we are doing, we may discover what we need.

Borgeat A, Ekatodramis G, Kalberer F, Benz C: Acute and nonacute complications associated with interscalene block and shoulder surgery: A prospective study. A nesthesiology 2001; 95: 875–80
Fanelli G, Casati A, Garancini P, Torri G: Nerve stimulator and multiple injections technique for upper and lower limb blockade: Failure rate, patient acceptance, and neurologic complication. Anesth Analg 1999; 88: 847–52