Introduction Continuous interscalene nerve block techniques are an effective form of targeted non-opioid postoperative analgesia for shoulder arthroplasty patients. One of the limiting risks, however, is potential phrenic nerve blockade with resulting hemidiaphragmatic paresis and respiratory compromise. While studies have focused on block-related technical aspects to limit the incidence of phrenic nerve palsy, little is known about other factors associated with increased risk of clinical respiratory complications in this population.
Methods A single-institution retrospective cohort study was conducted using electronic health records from adult patients who underwent elective shoulder arthroplasty with continuous interscalene brachial plexus blocks (CISB). Data collected included patient, nerve block, and surgery characteristics. Respiratory complications were categorized into four groups (none, mild, moderate, and severe). Univariate and multivariable analyses were conducted.
Results Among 1025 adult shoulder arthroplasty cases, 351 (34%) experienced any respiratory complication. These 351 were subdivided into 279 (27%) mild, 61 (6%) moderate, and 11 (1%) severe respiratory complications. In an adjusted analysis, patient-related factors were associated with an increased likelihood of respiratory complication: ASA Physical Status III (OR 1.69, 95% CI 1.21 to 2.36); asthma (OR 1.59, 95% CI 1.07 to 2.37); congestive heart failure (OR 1.99, 95% CI 1.19 to 3.33); body mass index (OR 1.06, 95% CI 1.03 to 1.09); age (OR 1.02, 95% CI 1.00 to 1.04); and preoperative oxygen saturation (SpO2). For every 1% decrease in preoperative SpO2, there was an associated 32% higher likelihood of a respiratory complication (OR 1.32, 95% CI 1.20 to 1.46, p<0.001).
Conclusions Patient-related factors that can be measured preoperatively are associated with increased likelihood of respiratory complications after elective shoulder arthroplasty with CISB.
- REGIONAL ANESTHESIA
- Brachial Plexus
- Pain Management
Data availability statement
Data are available on reasonable request.
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Contributors LX helped design the study, collected data, drafted and revised the initial manuscript, reviewed and approved the submitted manuscript and is the guarantor. DG helped design the study, collected data, drafted and revised the initial manuscript, reviewed and approved the submitted manuscript. AK helped design the study, analyzed data, drafted and revised the initial manuscript and figures, reviewed and approved the submitted manuscript. KK collected data, reviewed, edited and approved the submitted manuscript. SGM helped design the study, reviewed, edited and approved the submitted manuscript. ERM helped design the study, drafted and revised the initial manuscript, reviewed and approved the submitted manuscript.
Funding This research received financial support in the form of a research grant awarded to the primary investigator by the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Author note Sample Tweet: 'Preoperative oxygen saturation on room air is associated with respiratory complications in patients undergoing shoulder arthroplasty with continuous interscalene nerve blocks.'
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