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Kapukaya F, Ekinci M, Ciftci B, Atalay YO, Gölboyu BE, Kuyucu E, Demiraran Y. Erector spinae plane block vs interscalene brachial plexus block for postoperative analgesia management in patients who underwent shoulder arthroscopy. BMC Anesthesiol 2022; 22:142. [PMID: 35550031 PMCID: PMC9097375 DOI: 10.1186/s12871-022-01687-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Interscalene brachial plexus block (ISB) is the gold standard method used for postoperative analgesia after arthroscopic shoulder surgery. Ultrasound guided erector spinae plane block (ESPB) is an interfascial plane block. The aim of this study is to compare the analgesic efficacy of ESPB and ISB after shoulder arthroscopy. The primary outcome is the comparison of the perioperative and postoperative opioid consumptions. Methods Sixty patients with ASA score I-II planned for arthroscopic shoulder surgery were included in the study. ESPB was planned in Group ESPB (n = 30), and ISB was planned in Group ISB (n = 30). Intravenous fentanyl patient-controlled analgesia was administered to both groups in the postoperative period. Intraoperative and postoperative opioid and analgesic consumption of both groups, side effects and complications related to opioid use, postoperative pain scores and rescue analgesic use were recorded in the first 48 h postoperatively. Results Pain scores were significantly higher in the ESPB group in the first 4 h postoperatively than in the ISB group (p < 0.05). The total fentanyl consumption and number of patients using rescue analgesics in the postoperative period were significantly higher in the ESPB group (p < 0.05). The incidence of nausea in the postoperative period was significantly higher in the ESPB group (p < 0.05). Conclusions In our study, it was seen that ISB provided more effective analgesia management compared to ESPB in patients underwent shoulder arthroscopy surgery.
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Affiliation(s)
- Furkan Kapukaya
- Department of Anesthesiology and Reanimation, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mursel Ekinci
- Department of Anesthesiology and Reanimation, Bursa City Hospital, Bursa, Turkey
| | - Bahadir Ciftci
- Department of Anesthesiology and Reanimation, School of Medicine, Istanbul Medipol University, Istanbul, Turkey.
| | - Yunus Oktay Atalay
- Department of Anesthesiology and Reanimation, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Birzat Emre Gölboyu
- Department of Anesthesiology and Reanimation, School of Medicine, Katip Çelebi University, Izmir, Turkey
| | - Ersin Kuyucu
- Department of Orthopedics and Traumatology, Medical Park Bahçelievler Hospital, Istanbul, Turkey
| | - Yavuz Demiraran
- Department of Anesthesiology and Reanimation, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
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Srinivasan KK, Ryan J, Snyman L, O'Brien C, Shortt C. Can saline injection protect phrenic nerve? - A randomised controlled study. Indian J Anaesth 2021; 65:445-450. [PMID: 34248187 PMCID: PMC8252997 DOI: 10.4103/ija.ija_182_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/29/2021] [Accepted: 05/23/2021] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Various methods were attempted to reduce the incidence of phrenic nerve palsy during interscalene brachial plexus nerve block. Mechanism of phrenic palsy was presumed to be due to the spread of local anaesthetic anterior to the anterior scalene muscle. We hypothesised that by injecting saline in this anatomical location prior to performing an interscalene block might reduce the incidence of phrenic palsy. Methods This was a double-blinded randomised controlled study performed in a single-centre, university-teaching hospital. A total of 36 patients were randomised to either group C (conventional group) or group S (saline group). Ultrasound-guided interscalene block was administered with 20 ml of 0.25% levo-bupivacaine in both groups. Ten ml of normal saline was injected anterior to anterior scalene muscle in group S prior to performing interscalene block. A blinded radiologist performed diaphragmatic ultrasound pre- and post-operatively to document phrenic palsy. Bedside spirometry was used to perform baseline and post-operative pulmonary function test. The primary outcome was to look at the incidence of phrenic palsy as measured by diaphragmatic palsy on ultrasound performed by radiologist. Statistical Package for the Social Sciences (SPSS) version 25 was used for statistical analysis. Results Significantly less patients in the saline group developed diaphragmatic paresis when compared to conventional group (44% vs. 94%, Chi-squared = 10.01, P = 0.002). There was no difference in post-operative pain, subjective sensation of dyspnoea or patient satisfaction between the groups. Conclusion Injecting saline anterior to anterior scalene muscle reduces the incidence of diaphragmatic palsy when performing interscalene block.
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Affiliation(s)
| | - John Ryan
- Department of Anaesthesia and Intensive Care, Tallaght University Hospital, Dublin, Ireland
| | - Lindi Snyman
- Department of Anaesthesia and Intensive Care, Tallaght University Hospital, Dublin, Ireland
| | - Ciara O'Brien
- Department of Radiology, Tallaght University Hospital, Dublin, Ireland
| | - Conor Shortt
- Department of Radiology, Tallaght University Hospital, Dublin, Ireland
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Layera S, Saadawi M, Tran DQ, Salinas FV. Motor-Sparing Peripheral Nerve Blocks for Shoulder, Knee, and Hip Surgery. Adv Anesth 2020; 38:189-207. [PMID: 34106834 DOI: 10.1016/j.aan.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Sebastián Layera
- Department of Anesthesiology and Perioperative Medicine, Hospital Clínico Universidad de Chile, University of Chile, Office B222 Second Floor, Sector B, 999 Santos Dumont, Independencia, Santiago 8380456, Chile
| | - Mohammed Saadawi
- Department of Anesthesiology, St. Mary's Hospital, McGill University, 3830 Avenue Lacombe, Montreal, Quebec H3T-1M5, Canada
| | - De Q Tran
- Department of Anesthesiology, St. Mary's Hospital, McGill University, 3830 Avenue Lacombe, Montreal, Quebec H3T-1M5, Canada
| | - Francis V Salinas
- Department of Anesthesiology, US Anesthesia Partners-Washington, 600 Broadway, Suite 270, Seattle, WA 98122, USA.
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Affiliation(s)
- Neel Desai
- Specialist Registrar in Anaesthetics, Department of Anaesthetics, Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP
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Careskey M, Naidu R. Continuous Suprascapular Nerve Block With a Perineural Catheter for Reverse Shoulder Arthroplasty Rescue Analgesia in a Patient With Severe Chronic Obstructive Pulmonary Disease. ACTA ACUST UNITED AC 2016; 7:37-40. [PMID: 27258178 DOI: 10.1213/xaa.0000000000000338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Reverse open shoulder arthroplasty requires a comprehensive analgesic plan involving regional anesthesia. The commonly performed interscalene brachial plexus blockade confers a high likelihood of diaphragmatic paralysis via phrenic nerve palsy, making this option riskier in patients with limited pulmonary reserve. Continuous blockade of the suprascapular nerve, a more distal branch of the C5 and C6 nerve roots, may be a viable alternative. We report a successful case of the use of a suprascapular nerve block with continuous programmed intermittent bolus perineural analgesia in a patient with severe chronic obstructive pulmonary disease who underwent reverse open shoulder arthroplasty.
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Affiliation(s)
- Matthew Careskey
- From the Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California
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Palhais N, Brull R, Kern C, Jacot-Guillarmod A, Charmoy A, Farron A, Albrecht E. Extrafascial injection for interscalene brachial plexus block reduces respiratory complications compared with a conventional intrafascial injection: a randomized, controlled, double-blind trial † †This report was previously presented in part at the annual meeting of the European Society of Regional Anaesthesia and Pain Medicine, Ljubljana, Slovenia, September 2–5, 2015. Br J Anaesth 2016; 116:531-7. [DOI: 10.1093/bja/aew028] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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The effect of continuous interscalene brachial plexus block with 0.125% bupivacaine vs 0.2% ropivacaine on pain relief, diaphragmatic motility, and ventilatory function. J Clin Anesth 2015. [DOI: 10.1016/j.jclinane.2015.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Maybin J, Townsley P, Bedforth N, Allan A. Ultrasound guided supraclavicular nerve blockade: first technical description and the relevance for shoulder surgery under regional anaesthesia. Anaesthesia 2011; 66:1053-5. [DOI: 10.1111/j.1365-2044.2011.06907.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Superficial cervical plexus neuropathy after single-injection interscalene brachial plexus block. Anesth Analg 2009; 109:2008-11. [PMID: 19923533 DOI: 10.1213/ane.0b013e3181bbd98e] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Interscalene brachial plexus block (ISB) using the modified lateral approach provides a well-established method of anesthesia and analgesia for patients undergoing shoulder surgery. Considering the neural anatomy at the site of injection, the superficial cervical plexus may be at risk of injury. We evaluated the incidence and characteristics of superficial cervical plexus neuropathy. METHODS During a 1-yr period, 273 consecutive patients requiring single-injection ISB for shoulder or proximal arm surgery were studied. Patients were examined for symptoms compatible with superficial cervical plexus injury before surgery, 24 h postoperatively, and contacted by telephone 31 days after surgery. Symptomatic patients received an additional phone call 6 mo after surgery. RESULTS Twenty-four hours after shoulder surgery, 21 patients (7.7%) showed symptoms consistent with superficial cervical plexus neuropathy. Symptoms consisted of hypesthesia in 1-4 cutaneous branches of the cervical plexus. Five patients (1.8%) reported symptoms that lasted for >31 days. All symptoms had entirely resolved after 6 mo. CONCLUSIONS Superficial cervical plexus neuropathy is not uncommon after ISB using the modified lateral approach and the possibility should be discussed with patients preprocedurally.
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Smith HM, Duncan CM, Hebl JR. Clinical utility of low-volume ultrasound-guided interscalene blockade: contraindications reconsidered. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1251-1258. [PMID: 19710225 DOI: 10.7863/jum.2009.28.9.1251] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this series is to describe cases in which ultrasound guidance was used to allow patients to receive the benefits of regional anesthesia while safely circumventing traditional contraindications to interscalene blockade (ISB). METHODS Targeted low-volume ISB was performed in 3 patients in whom this procedure would typically be contraindicated because of phrenic nerve blockade or risk of local anesthetic toxicity. A patient with severe respiratory dysfunction, a patient undergoing bilateral shoulder surgery, and a patient requiring awake fiberoptic intubation underwent low-volume ultrasound-guided ISB. The ultrasound technique involved the use a low local anesthetic volume, anatomic identification of the brachial plexus trunk, needle placement opposite the phrenic nerve position, and control over local anesthetic spread. RESULTS In both patients in whom diaphragmatic paralysis was a concern, postoperative respiratory parameters indicated successful regional analgesia without evidence of phrenic nerve blockade. In the patient requiring an additional regional anesthetic procedure, ISB was performed with a local anesthetic volume low enough to avoid exceeding toxic safety thresholds. CONCLUSIONS Although further studies are warranted, we report on 3 cases in which ultrasound guidance was used to allow patients to receive the benefits of regional anesthesia while safely avoiding standard contraindications to ISB. Ultrasound technology may allow providers to perform low-volume brachial plexus blockade while avoiding issues related to phrenic nerve blockade and systemic local anesthetic toxicity.
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Affiliation(s)
- Hugh M Smith
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN 55905 USA.
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Neal JM, Gerancher JC, Hebl JR, Ilfeld BM, McCartney CJL, Franco CD, Hogan QH. Upper extremity regional anesthesia: essentials of our current understanding, 2008. Reg Anesth Pain Med 2009; 34:134-70. [PMID: 19282714 PMCID: PMC2779737 DOI: 10.1097/aap.0b013e31819624eb] [Citation(s) in RCA: 201] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Brachial plexus blockade is the cornerstone of the peripheral nerve regional anesthesia practice of most anesthesiologists. As part of the American Society of Regional Anesthesia and Pain Medicine's commitment to providing intensive evidence-based education related to regional anesthesia and analgesia, this article is a complete update of our 2002 comprehensive review of upper extremity anesthesia. The text of the review focuses on (1) pertinent anatomy, (2) approaches to the brachial plexus and techniques that optimize block quality, (4) local anesthetic and adjuvant pharmacology, (5) complications, (6) perioperative issues, and (6) challenges for future research.
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Affiliation(s)
- Joseph M Neal
- Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA, USA.
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Tran QHD, Clemente A, Doan J, Finlayson RJ. Brachial plexus blocks: a review of approaches and techniques. Can J Anaesth 2007; 54:662-74. [PMID: 17666721 DOI: 10.1007/bf03022962] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The purpose of this narrative review is to summarize the evidence derived from randomized controlled trials (RCTs) regarding established approaches and techniques for brachial plexus anesthesia. SOURCE Using the MEDLINE (January 1966 to November 2006) and EMBASE (January 1980 to November 2006) databases, key words "brachial plexus", "nerve blocks", "interscalene", "cervical paravertebral", "suprascapular", "supraclavicular", "infraclavicular", "axillary", "brachial canal" and "humeral canal" were searched for full text articles pertaining to the evaluation of recognized approaches and techniques for brachial plexus anesthesia. The search was limited to RCTs involving human subjects and published in the English language. Seventy-six RCTs were identified. PRINCIPAL FINDINGS Many of the published studies were underpowered and contained various methodological limitations. We found that, for shoulder and proximal humeral surgery, interscalene and cervical paravertebral approaches to the brachial plexus appear to provide equally effective surgical anesthesia. Intersternocleidomastoid supraclavicular blocks are not associated with improved postoperative analgesia despite eliciting more complete anesthesia of the brachial plexus. For surgery at or below the elbow, an infraclavicular block may result in decreased performance time and block-related pain while providing similar efficacy compared to (multiple-stimulation) axillary and brachial canal approaches. With respect to technique, it is unclear if nerve stimulation provides a more effective interscalene block than elicitation of paresthesiae. For supraclavicular blocks, nerve stimulation with a minimal threshold of 0.9 mA is recommended, whereas a double-stimulation technique is optimal for infraclavicular blocks. For the axillary approach, a triple-stimulation technique, involving injections of the musculocutaneous, median and radial nerves, is the most effective option. CONCLUSIONS Published reports of RCTs provide evidence to formulate limited recommendations regarding optimal approaches and techniques for brachial plexus anesthesia. Further well-designed and meticulously executed RCTs are warranted, particularly in light of new techniques involving ultrasound or combining neurostimulation and echoguidance.
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Affiliation(s)
- Quang Hieu De Tran
- Montreal General Hospital, Department of Anesthesia, McGill University, Montreal, Quebec, Canada.
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Delcourt J, Barré J, Lelarge C, Payen M, Malinovsky JM. Delayed respiratory depression after interscalene blockade for shoulder surgery in geriatric patients. Can J Anaesth 2006; 53:110-1. [PMID: 16371624 DOI: 10.1007/bf03021543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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The indications and applications of interscalene brachial plexus block for surgery about the shoulder. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.acpain.2004.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ryu TH, Jeon YH, Lim DG. Postoperative Analgesia in Dyspneic Patient after Interscalene Brachial Plexus Block with General Anesthesia -A case report-. Korean J Pain 2004. [DOI: 10.3344/jkps.2004.17.2.266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Tae Ha Ryu
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Young Hoon Jeon
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Dong Gun Lim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kyungpook National University Hospital, Daegu, Korea
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Long TR, Wass CT, Burkle CM. Perioperative interscalene blockade: an overview of its history and current clinical use. J Clin Anesth 2002; 14:546-56. [PMID: 12477594 DOI: 10.1016/s0952-8180(02)00408-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Use of single-dose and continuous interscalene brachial plexus block (ISB) are gaining widespread popularity. When compared with general anesthesia, ISB has been reported to provide superior postoperative analgesia with fewer side effects, and it is associated with greater patient satisfaction. Anatomical landmarks are readily identifiable, which contributes to the ease of performing this block. In the future, we anticipate increased use of continuous interscalene catheters or injection of biodegradable local anesthetic impregnated microspheres to provide prolonged perioperative outpatient analgesia.
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Affiliation(s)
- Timothy R Long
- Department of Anesthesiology, Mayo Clinic and Mayo Medical School, Rochester, MN 55905, USA.
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Harrop-Griffiths W, Sinha A, Ahmad K. A reply. Anaesthesia 2001. [DOI: 10.1046/j.1365-2044.2001.02181-30.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Koscielniak-Nielsen ZJ. Hemidiaphragmatic paresis after interscalene supplementation of insufficient axillary block with 3 mL of 2% mepivacaine. Acta Anaesthesiol Scand 2000; 44:1160-2. [PMID: 11028741 DOI: 10.1034/j.1399-6576.2000.440922.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Breathing difficulty, agitation, and confusion developed in a 55-year-old male, ASA classification group III with a non-small-cell lung cancer 10 min after interscalene supplementation of insufficient axillary block with 3 mL of 2% mepivacaine with adrenaline 5 microg mL(-1). After administration of thiopentone and suxamethonium the patient's trachea was intubated and the lungs were ventilated with oxygen-enriched air. The block was successful and surgery was conducted as scheduled. Radiographic monitoring of the lungs at the end of operation showed ipsilateral elevation of the diaphragm with reduced respiratory excursions. Postoperatively, the patient was somnolent and hypercapnic, but maintained satisfactory oxygenation while breathing spontaneously and was extubated. Both the temporal relationship of events and the regression of all symptoms within three hours suggest that 3 mL of mepivacaine with adrenaline injected into the interscalene space blocked the phrenic nerve and compromised diaphragmatic function, which precipitated the respiratory failure.
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Affiliation(s)
- Z J Koscielniak-Nielsen
- Department of Anaesthesia and Intensive Therapy, Copenhagen University Hospital, Rigshospitalet, Denmark.
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Petitfaux F, Pham-Dang C, Dupas B, Camps C, Blanche E, Legendre E, Pinaud M. [Diaphragmatic excursion after inter-sternocleidomastoid block depending on the site of the injection]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2000; 19:517-22. [PMID: 10976366 DOI: 10.1016/s0750-7658(00)00246-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the incidence of the hemidiaphragmatic paresis after inter Sterno-Cleido-Mastoid (inter-SCM) block. STUDY DESIGN Prospective, comparative, single blind study. PATIENTS 16 patients ASA I-II. METHODS The diaphragmatic paresis was measured by a radiologist unaware of the technique used and operated side. It was determined by the diaphragmatic excursion (DE) on double-exposure chest radiography, obtained preoperatively and postoperatively (DE-pre, DE-post) for the ipsilateral and controlateral side of the inter-SCM block. All the patients were given 20 mL 0.5% bupivacaine plus 20 mL 2% lidocaine both with epinephrine. These anesthetics were injected via the stimuling needle or via the catheter after opacified radiological control of the catheter position. The patients were divided into 2 groups. Group 1: injection via the needle after eliciting flexion of fingers, or via a catheter into infraclavicular position; group 2: injection via the needle after eliciting contraction of deltoid, or elbow flexion, or via a supraclavicular catheter. RESULTS All the patients had satisfactory block. The ipsilateral DE was decreased after injection of anesthetics in group 2 (P < 0.001) while it remained unchanged in group 1. CONCLUSION The diaphragmatic paresis is avoidable with the inter-SCM block if and only if the anesthetic solution is injected via the needle after stimulating flexion of fingers or via a catheter into infraclavicular position.
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Affiliation(s)
- F Petitfaux
- Service d'anesthésie-réanimation chirurgicale, Hôtel-Dieu, Nantes, France
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Casati A, Fanelli G, Cedrati V, Berti M, Aldegheri G, Torri G. Pulmonary Function Changes After Interscalene Brachial Plexus Anesthesia with 0.5% and 0.75% Ropivacaine. Anesth Analg 1999. [DOI: 10.1213/00000539-199903000-00024] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Casati A, Fanelli G, Cedrati V, Berti M, Aldegheri G, Torri G. Pulmonary function changes after interscalene brachial plexus anesthesia with 0.5% and 0.75% ropivacaine: a double-blinded comparison with 2% mepivacaine. Anesth Analg 1999; 88:587-92. [PMID: 10072012 DOI: 10.1097/00000539-199903000-00024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
UNLABELLED The purpose of this investigation was to compare, in a prospective, double-blinded fashion, 0.5% and 0.75% ropivacaine with 2% mepivacaine to determine their effects on respiratory function during interscalene brachial plexus (IBP) anesthesia. With ethical committee approval and written, informed consent, 30 healthy patients presenting for elective shoulder capsuloplastic or acromioplastic procedures were randomized to receive IBP anesthesia by 20 mL of either 0.5% ropivacaine (n = 10), 0.75% ropivacaine (n = 10), or 2% mepivacaine (n = 10). Block onset time, pulmonary function variables, ipsilateral hemidiaphragmatic motion (ultrasonographic evaluation), and first requirement of postoperative analgesic were evaluated. Surgical anesthesia (loss of pinprick sensation from C4 to C7 and motor block of the shoulder joint) was achieved later with 0.5% ropivacaine than with either 0.75% ropivacaine or 2% mepivacaine (P < 0.05), whereas the first pain medication was requested later with both ropivacaine concentrations than with mepivacaine (P < 0.0005). No differences in quality of the block or patient acceptance were observed in the three groups. All 30 patients had ipsilateral hemidiaphragmatic paresis and large mean decreases in forced vital capacity (ropivacaine 0.5%: 40% +/- 17%, ropivacaine 0.75%: 41% +/- 22%, mepivacaine 2%: 39% +/- 21%) and forced expiratory volume at 1 s (ropivacaine 0.5%: 30% +/- 19%, ropivacaine 0.75%: 38% +/- 26%, mepivacaine 2%: 40% +/- 10%). We conclude that, when performing IBP anesthesia, 0.5% ropivacaine does not decrease the incidence of ipsilateral paresis of the hemidiaphragm compared with 0.75% ropivacaine and 2% mepivacaine. IMPLICATIONS During the first 30 min after placing interscalene brachial plexus anesthesia, 0.5% ropivacaine does not provide clinically relevant advantages in terms of pulmonary function changes compared with either 0.75% ropivacaine or 2% mepivacaine. However, 0.75% ropivacaine allows a short onset, similar to that of mepivacaine, with long postoperative analgesia.
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Affiliation(s)
- A Casati
- Department of Anesthesiology, University of Milan, Italy.
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An attempt to prevent spread of local anaesthetic to the phrenic nerve by compression above the injection site during the interscalene brachial plexus block. Eur J Anaesthesiol 1998. [DOI: 10.1097/00003643-199807000-00011] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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