Background and Aims This study compares the perioperative complication rates of interscalene brachial plexus catheters (ISC) alone compared to the combination with general anaesthesia (GA) for total shoulder replacement in high risk patients.
Methods 196 patients (ASA≥III), undergoing elective total shoulder replacement between 2014 and 2020 were included retrospectively. The data of 107 patients scheduled for isolated ISC were compared to those of 89 patients with planned GA in addition to ISC. Cardiovascular complications are defined as a decrease in MAP >20% of preoperative MAP, hypertension and tachycardia requiring therapy. Logistic regression analysis was used to calculate univariable and multivariable odds ratios (OR; 95% confidence interval).
Results The ISC group showed a significantly better hemodynamic stability during surgery with less vasopressor consumption (Ephedrine-Bolus:31% vs. 73% p<0.001, Norepinephrine/Phenylephrine Bolus: 7% vs. 35% p< 0.001) and less volume supplementation (1069 ml ±463 vs 1308 ±501 p<0.001). Relevant hypotension occurred less frequently (35% vs 82% p < 0.001). (1) Regarding postoperative complications, we found a decreased risk of respiratory (4% vs. 12% p < 0.02) as well as cardiovascular complications (15% vs. 38% p < 0.001) in the ISC group. (3) General anaesthesia remained an independent risk factor for cardiovascular complications after the adjustment for potential confounders (OR: 5.9; 95% CI 2.4- 14.1).
Conclusions Isolated ISC can be considered as superior to combined anaesthesia for total shoulder replacement (2) even in cardiovascular high-risk patients.
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