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  • Rate of occurrence of respiratory complications in patients who undergo shoulder arthroplasty with a continuous interscalene brachial plexus block and associated risk factors

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Original research
Rate of occurrence of respiratory complications in patients who undergo shoulder arthroplasty with a continuous interscalene brachial plexus block and associated risk factors
  1. Lei Xu1,
  2. Daniel Gessner1,
  3. Alex Kou1,2,
  4. Ksenia Kasimova1,
  5. Stavros G Memtsoudis3,4 and
  6. Edward R Mariano1,2
  1. 1 Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
  2. 2 Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
  3. 3 Departments of Anesthesiology and Public Health, Weill Cornell Medical College, New York, NY, USA
  4. 4 Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA
  1. Correspondence to Dr Lei Xu, Stanford University, Stanford, CA 94305, USA; leixu{at}stanford.edu

Abstract

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.

  • COMPLICATIONS
  • REGIONAL ANESTHESIA
  • Brachial Plexus
  • Pain Management

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/rapm-2022-104264

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Twitter @lxu_md, @sgmemtsoudis, @EMARIANOMD

    • 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.'

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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