ShoulderDiaphragm function after interscalene brachial plexus block: a double-blind, randomized comparison of 0.25% and 0.125% bupivacaine
Section snippets
Materials and methods
After providing written informed consent, 30 adults scheduled for outpatient arthroscopic RC repair were enrolled by the anesthesiologists in this single-center, randomized, double-blind trial conducted at an ambulatory surgical center in the United States. This study was registered at ClinicalTrials.gov. Patients with a history of lung disease, obstructive sleep apnea, chronic opioid use, or known dysfunction of the diaphragm were excluded.
Before sedation and ISBPB placement, the ipsilateral
Results
The study enrolled 30 patients, with 15 patients each assigned to the 0.125% and 0.25% bupivacaine groups. One patient in the 0.25% bupivacaine group asked to be withdrawn before block placement. One patient in the 0.125% bupivacaine group was excluded intraoperatively when the arthroscopic procedure was changed to an open procedure with muscle transfer. Arthroscopy and debridement without RC repair occurred in 2 patients in the 0.25% group and in 1 patient in the 0.125% group. Data were
Discussion
ISBPB is an effective technique for providing analgesia after shoulder surgery. Although it provides excellent pain relief, ISBPB is associated with diaphragm dysfunction and hypoxemia.2, 4, 17, 20, 22, 23 Avoiding diaphragm dysfunction is especially important in older patients, in whom conditions such as sleep apnea, obesity, and chronic obstructive pulmonary disease may already compromise pulmonary function. Furthermore, postoperative hypoxemia may result in diagnostic tests or unanticipated
Conclusion
For pain control after arthroscopic RC repair, diaphragm function and oxygen saturation were superior with ISBPB performed using 20 mL of 0.125% compared with 0.25% bupivacaine. Equally important, there were no clinically significant differences between groups in pain scores and no statistically significant differences in opioid requirements or patient satisfaction. These results may have important safety implications related to the maintenance of diaphragm function and oxygenation as well as
Disclaimer
The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
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Postoperative Pain Control After Arthroscopic Rotator Cuff Repair: Arthroscopy-Guided Continuous Suprascapular Nerve Block Versus Ultrasound-Guided Continuous Interscalene Block
2021, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :Also, there were reports that for reducing rebound pain, continuous nerve block using indwelling catheter was more effective than single.8,9 Although ISB catheterization is one of the most effective methods, it can cause complications such as phrenic nerve palsy/pneumothorax and temporal brachial partial palsy.4,31-34 Although we did not observe any case of pneumothorax, hemidiaphragmatic paresis occurred in 85% of patients in the US-ISB group.
Motor-Sparing Peripheral Nerve Blocks for Shoulder, Knee, and Hip Surgery
2020, Advances in AnesthesiaCitation Excerpt :In contemporary practice, US guidance has revolutionized regional anesthesia by enabling operators to visualize the needle, target nerve(s), and LA spread [12,13]. Consequently, US-guided ISB using lower LA volumes (3–10 mL) [14–18], dilute LA concentrations [19,20], and LA injection 4 mm [21] lateral to the brachial plexus, have decreased the occurrence of HDP. Unfortunately, even with US guidance, the latter’s incidence can still reach 20% [1], thereby prompting the investigation of alternative nerve blocks for shoulder surgery.
Continuous Interscalene Brachial Plexus Blocks: An Anatomical Challenge between Scylla and Charybdis?
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This study was approved by the University of Utah Institutional Review Board (IRB 00026846) on May 14, 2008.