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Huang L, Li P, Zhang L, Kang G, Zhou H, Zhao Z. Analgesic comparison between perineural and intravenous dexamethasone for shoulder arthroscopy: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2022; 17:103. [PMID: 35177116 PMCID: PMC8851776 DOI: 10.1186/s13018-022-02952-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction The analgesic comparison between perineural and intravenous dexamethasone on interscalene block for pain management after shoulder arthroscopy remains controversial. We conduct this meta-analysis to explore the influence of perineural versus intravenous dexamethasone on interscalene block for pain control after shoulder arthroscopy. Methods We have searched PubMed, Embase, Web of science, EBSCO and Cochrane library databases through April 2021 and included randomized controlled trials (RCTs) assessing the effect of perineural and intravenous dexamethasone on interscalene block in patients with shoulder arthroscopy. Results Five RCTs were included in the meta-analysis. Overall, compared with intravenous dexamethasone for shoulder arthroscopy, perineural dexamethasone led to similar block duration (SMD = 0.12; 95% CI − 0.12 to 0.35; P = 0.33), pain scores at 12 h (SMD = − 0.67; 95% CI − 1.48 to 0.15; P = 0.11), pain scores at 24 h (SMD = − 0.33; 95% CI − 0.79 to 0.14; P = 0.17), opioid consumption (SMD = 0.01; 95% CI − 0.18 to 0.19; P = 0.95) and incidence of nausea/vomiting (OR = 0.74; 95% CI 0.38–1.44; P = 0.38). Conclusions Perineural and intravenous dexamethasone demonstrated comparable pain relief after shoulder arthroscopy.
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Affiliation(s)
- Liangku Huang
- Department of Hand Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, 710054, Shaanxi, China
| | - Peng Li
- Department of Hand Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, 710054, Shaanxi, China
| | - Liang Zhang
- Sports Medicine Center, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 555 Youyidong Street, Beilin District, Xi'an, 710054, Shaanxi, China
| | - Guangming Kang
- Department of Hand Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, 710054, Shaanxi, China
| | - Haizhen Zhou
- Department of Orthopaedic Oncology, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, 710054, Shaanxi, China
| | - Zandong Zhao
- Sports Medicine Center, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 555 Youyidong Street, Beilin District, Xi'an, 710054, Shaanxi, China.
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Analgesic efficacy of ultrasound-guided interscalene block vs. supraclavicular block for ambulatory arthroscopic rotator cuff repair: A randomised noninferiority study. Eur J Anaesthesiol 2020; 36:778-786. [PMID: 31361631 PMCID: PMC6738543 DOI: 10.1097/eja.0000000000001065] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ultrasound-guided interscalene block (ISB) is the reference technique for pain control after ambulatory upper limb surgery, but supraclavicular block (SCB) is an alternative. OBJECTIVES The aim of this study was to compare the efficacy of SCB vs. ISB in patients undergoing ambulatory arthroscopic rotator cuff repair (ARCR), with the hypothesis of noninferiority of SCB analgesia compared with ISB. DESIGN A randomised, single-blind, noninferiority study. SETTING Hôpital Privé Jean Mermoz, Centre Paul Santy, Lyon, France. PATIENTS Ambulatory ARCR patients. INTERVENTION Patients were randomly allocated (1 : 1) to receive a single injection SCB or ISB, as well as general anaesthesia. All patients received a postoperative analgesic prescription for home use before leaving hospital (including fast-acting oral morphine sulphate). Patients completed a telephone questionnaire on days 1 and 2 postsurgery. MAIN OUTCOME MEASURES Primary endpoint was oral morphine consumption (mg) during the first 2 days postsurgery. If the difference between mean morphine consumption in the SCB vs. ISB group was less than 30 mg, noninferiority of SCB compared with ISB would be demonstrated. Secondary evaluation criteria included pain scores (numerical rating scale), duration of motor and sensory blockade, and satisfaction with treatment. RESULTS The per-protocol cohort included 103 patients (SCB = 52, ISB = 51) (57% men, median age 58 years). Mean morphine consumption in the 48 h postsurgery was 9.4 vs. 14.7 mg in the SCB and ISB groups, respectively (difference −5.3, P < 0.001). The upper limit of the 95% CI was less than 30 mg, demonstrating noninferiority of SCB compared with ISB. No difference was observed between the two groups in terms of pain scores or the duration of motor or sensory blockade. Overall, 98% of patients in the SCB group vs. 90% in the ISB group were satisfied with their treatment. CONCLUSION SCB is as effective as ISB in terms of postoperative analgesia based on oral morphine consumption in patients undergoing ambulatory ARCR. TRIAL REGISTRATION EudraCT number: 2016-A00747-47.
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Ferré F, Pommier M, Laumonerie P, Ferrier A, Menut R, Bosch L, Balech V, Bonnevialle N, Minville V. Hemidiaphragmatic paralysis following ultrasound‐guided anterior vs. posterior suprascapular nerve block: a double‐blind, randomised control trial. Anaesthesia 2020; 75:499-508. [DOI: 10.1111/anae.14978] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2019] [Indexed: 12/26/2022]
Affiliation(s)
- F. Ferré
- Département d'Anesthésie Réanimation Centre Hospitalier Universitaire de Toulouse Purpan Hôpital Riquet Université Toulouse 3‐Paul Sabatier Toulouse France
| | - M. Pommier
- Département d'Anesthésie Réanimation Centre Hospitalier Universitaire de Toulouse Purpan Hôpital Riquet Université Toulouse 3‐Paul Sabatier Toulouse France
| | - P. Laumonerie
- Département d'Orthopédie Traumatologie Centre Hospitalier Universitaire de Toulouse Purpan Hôpital Riquet Université Toulouse 3‐Paul Sabatier Toulouse France
| | - A. Ferrier
- Département d'Anesthésie Réanimation Centre Hospitalier Universitaire de Toulouse Purpan Hôpital Riquet Université Toulouse 3‐Paul Sabatier Toulouse France
| | - R. Menut
- Département d'Anesthésie Réanimation Centre Hospitalier Universitaire de Toulouse Purpan Hôpital Riquet Université Toulouse 3‐Paul Sabatier Toulouse France
| | - L. Bosch
- Département d'Anesthésie Réanimation Centre Hospitalier Universitaire de Toulouse Purpan Hôpital Riquet Université Toulouse 3‐Paul Sabatier Toulouse France
| | - V. Balech
- Département d'Anesthésie Réanimation Centre Hospitalier Universitaire de Toulouse Purpan Hôpital Riquet Université Toulouse 3‐Paul Sabatier Toulouse France
| | - N. Bonnevialle
- Département d'Orthopédie Traumatologie Centre Hospitalier Universitaire de Toulouse Purpan Hôpital Riquet Université Toulouse 3‐Paul Sabatier Toulouse France
| | - V. Minville
- Département d'Anesthésie Réanimation Centre Hospitalier Universitaire de Toulouse Purpan Hôpital Riquet Université Toulouse 3‐Paul Sabatier Toulouse France
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Marty P, Ferré F, Basset B, Marquis C, Bataille B, Chaubard M, Merouani M, Rontes O, Delbos A. Diaphragmatic paralysis in obese patients in arthroscopic shoulder surgery: consequences and causes. J Anesth 2018; 32:333-340. [PMID: 29511891 DOI: 10.1007/s00540-018-2477-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/28/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Ambulatory process in arthroscopic shoulder surgery has boomed over past decades. Some anesthetic techniques such as interscalene block (ISB) and its surrogates are associated with diaphragmatic paralysis and might compromise outpatient procedure. HYPOTHESIS This study aims to assess consequences of diaphragmatic paralysis in obese patients. METHODS This prospective observational study screened patients with body mass index (BMI) ≥ 30 kg/m2 undergoing acromioplasty or supraspinatus tendon repair. Surgery was performed using brachial plexus block, and the method of brachial plexus block was left at the discretion of attending anesthesiologists. Post-operative hemidiaphragmatic paralysis was evaluated using M-mode ultrasonography and its consequences on patient ventilation were assessed: occurrence of hypoxic episode defined as oxygen saturation less than 90% (by pulse oximeter) in room air, dyspnea and failure of ambulatory procedure. Causes of diaphragmatic paralysis were also analyzed. RESULTS Ninety-one patients were screened, 82 patients were included in this study and 37 patients (45%) presented diaphragmatic paralysis. Compared to patients without diaphragmatic paralysis, diaphragmatic paralysis was associated with dyspnea [10 (27%) versus 1 (2%); p = 0.0019], occurrence of patients presenting at least one hypoxic episode [6 (16%) versus 1 (2%); p = 0.02] and failure of ambulatory process [10 (27%) versus 1 (2%); p = 0.009]. The combination of axillary and suprascapular nerve blocks, but also low volume ISB, was found to be protective against diaphragmatic paralysis when compared to high volume ISB [Odds ratios 0.0019 (0.001-0.026) and 0.0482 (0.008-0.27), respectively; p < 0.001]. CONCLUSION In patients with BMI ≥ 30 kg/m2 undergoing arthroscopic shoulder surgery, diaphragmatic paralysis is associated with dyspnea, occurrence of hypoxic episodes and failure of ambulatory procedure. High volume ISB and also, to a lesser extent, low volume ISB were found to be responsible for diaphragmatic paralysis. TRIAL REGISTRY NUMBER Registration n° 2014-202.
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Affiliation(s)
- Philippe Marty
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France.
| | - Fabrice Ferré
- Département Anesthésie-Réanimation, Hôpital Pierre-Paul Riquet, CHU Purpan, 31059, Toulouse, France
| | - Bertrand Basset
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France
| | - Constance Marquis
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France
| | - Benoit Bataille
- Department of Intensive Care, Centre hospitalier Hôtel-Dieu, Narbonne, France
| | - Martine Chaubard
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France
| | - Mehdi Merouani
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France
| | - Olivier Rontes
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France
| | - Alain Delbos
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France
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Flaherty JM, Auyong DB, Hanson NA. Bilateral Continuous Suprascapular Nerve Blocks for Bilateral Shoulder Hemiarthroplasty. ACTA ACUST UNITED AC 2016; 7:125-8. [DOI: 10.1213/xaa.0000000000000364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abd El-Hamid A, Alrabiey MI. Dexamethasone added to levobupivacaine prolongs ultrasound-guided interscalene brachial plexus blockade: a prospective, randomized, controlled study. AIN-SHAMS JOURNAL OF ANAESTHESIOLOGY 2016; 9:422. [DOI: 10.4103/1687-7934.189099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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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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Jadon A, Dixit S, Kedia SK, Chakraborty S, Agrawal A, Sinha N. Interscalene brachial plexus block for shoulder arthroscopic surgery: Prospective randomised controlled study of effects of 0.5% ropivacaine and 0.5% ropivacaine with dexamethasone. Indian J Anaesth 2015; 59:171-6. [PMID: 25838589 PMCID: PMC4378078 DOI: 10.4103/0019-5049.153039] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Various adjuvants have been used to prolong the duration of local anaesthetic action after peripheral and regional nerve blocks. We evaluated the effect of dexamethasone on the duration of pain relief in shoulder arthroscopic surgeries performed under interscalene brachial plexus using ropivacaine as local anaesthetic. METHODS After Ethical Committee approval and informed consent from patients we performed a prospective, randomised, comparative study on patients scheduled for arthroscopic shoulder surgery under interscalene block (ISB). Patients in ropivacaine group (Group R) received 30 ml of 0.5% ropivacaine plus 2 ml normal saline (n = 50) and dexamethasone-ropivacaine (Group RD) received 0.5% ropivacaine 30 ml plus 8 mg dexamethasone (4 mg/ml) (n = 50). Duration of analgesia, onset of sensory and motor block, success and failure of block, and complications were recorded and compared. Computer software SPSS version-16 (SPSS Inc., Chicago, Illinois, USA) was used for statistical analysis. Chi-square test and Student's t-test were used and P < 0.05 was considered as significant. RESULTS The mean duration of analgesia in Group RD was 1103.72 ± 296.027 min and in Group R it was 551.54 ± 166.92 min (P = 0.0001). Onset of sensory block in Group RD was 12.24 ± 1.88 min and in Group R was 13.48 ± 1.81 min (P = 0.5170). Onset of motor block in Group RD was 16.24 ± 2.04 min and in Group R was 17.76 ± 2.21 min (P = 0.2244). Onset of surgical anaesthesia in Group RD was19.46 ± 1.86 min and in Group R was 20.84 ± 1.71 min (P = 0.0859). CONCLUSION Dexamethasone significantly prolonged duration of analgesia of ropivacaine during ISB used for arthroscopic surgeries of shoulder. Dexamethasone when mixed with ropivacaine had no effect on the onset of sensory and motor effects of ISB with ropivacaine.
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Affiliation(s)
- Ashok Jadon
- Department of Anaesthesia, Tata Motors Hospital, Jamshedpur, Jharkhand, India
| | - Shreya Dixit
- Department of Anaesthesia, Tata Motors Hospital, Jamshedpur, Jharkhand, India
| | - Sunil Kr Kedia
- Department of Anaesthesia, Tata Motors Hospital, Jamshedpur, Jharkhand, India
| | | | - Amit Agrawal
- Department of Anaesthesia, Tata Motors Hospital, Jamshedpur, Jharkhand, India
| | - Neelam Sinha
- Department of Anaesthesia, Tata Motors Hospital, Jamshedpur, Jharkhand, India
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Stundner O, Rasul R, Chiu YL, Sun X, Mazumdar M, Brummett CM, Ortmaier R, Memtsoudis SG. Peripheral nerve blocks in shoulder arthroplasty: how do they influence complications and length of stay? Clin Orthop Relat Res 2014; 472:1482-8. [PMID: 24166076 PMCID: PMC3971209 DOI: 10.1007/s11999-013-3356-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Regional anesthesia has proven to be a highly effective technique for pain control after total shoulder arthroplasty. However, concerns have been raised about the safety of upper-extremity nerve blocks, particularly with respect to the incidence of perioperative respiratory and neurologic complications, and little is known about their influence, if any, on length of stay after surgery. QUESTIONS/PURPOSES Using a large national cohort, we asked: (1) How frequently are upper-extremity peripheral nerve blocks added to general anesthesia in patients undergoing total shoulder arthroplasty? (2) Are there differences in the incidence of and adjusted risk for major perioperative complications and mortality between patients receiving general anesthesia with and without nerve blocks? And (3) does resource utilization (blood product transfusion, intensive care unit admission, length of stay) differ between groups? METHODS We searched a nationwide discharge database for patients undergoing total shoulder arthroplasty under general anesthesia with or without addition of a nerve block. Groups were compared with regard to demographics, comorbidities, major perioperative complications, and length of stay. Multivariable logistic regressions were performed to measure complications and resource use. A negative binomial regression was fitted to measure length of stay. RESULTS We identified 17,157 patients who underwent total shoulder arthroplasty between 2007 and 2011. Of those, approximately 21% received an upper-extremity peripheral nerve block in addition to general anesthesia. Patients receiving combined regional-general anesthesia had similar mean age (68.6 years [95% CI: 68.2-68.9 years] versus 69.1 years [95% CI: 68.9-69.3 years], p < 0.0043), a slightly lower mean Deyo (comorbidity) index (0.87 versus 0.93, p = 0.0052), and similar prevalence of individual comorbidities, compared to those patients receiving general anesthesia only. Addition of regional anesthesia was not associated with different odds ratios for complications, transfusion, and intensive care unit admission. Incident rates for length of stay were also similar between groups (incident rate ratio = 0.99; 95% CI: 0.97-1.02; p = 0.467) CONCLUSIONS: Addition of regional to general anesthesia was not associated with an increased complication profile or increased use of resources. In combination with improved pain control as known from previous research, regional anesthesia may represent a viable management option for shoulder arthroplasty. However, further research is necessary to better clarify the risk of neurologic complications. LEVEL OF EVIDENCE Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ottokar Stundner
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria
| | - Rehana Rasul
- Division of Biostatistics and Epidemiology, Department of Public Health, Weill Medical College of Cornell University, New York, NY USA
| | - Ya-Lin Chiu
- Division of Biostatistics and Epidemiology, Department of Public Health, Weill Medical College of Cornell University, New York, NY USA
| | - Xuming Sun
- Division of Biostatistics and Epidemiology, Department of Public Health, Weill Medical College of Cornell University, New York, NY USA
| | - Madhu Mazumdar
- Division of Biostatistics and Epidemiology, Department of Public Health, Weill Medical College of Cornell University, New York, NY USA
| | - Chad M. Brummett
- Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI USA
| | - Reinhold Ortmaier
- Department of Trauma Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Stavros G. Memtsoudis
- Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY USA
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Sanchez M, Malhotra N, Lin L. End-Stage Pulmonary Disease and Brachial Plexus Regional Anesthesia. Semin Cardiothorac Vasc Anesth 2012; 16:59-64. [DOI: 10.1177/1089253211433362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The authors present the challenging clinical scenario of managing a patient with end-stage chronic obstructive pulmonary disease requiring anesthesia for a proximal humerus open reduction and internal fixation who likely would have failed to wean from mechanical ventilation if general anesthesia and endotracheal intubation had been chosen as the maintenance technique. They discuss the effects of general and regional anesthesia on respiratory physiology and describe the perioperative implications of severe pulmonary disease. They also review the various brachial plexus block options that could achieve a satisfactory outcome, with the objective of helping guide practitioners to a rational choice of anesthetic techniques when caring for patients with end-stage pulmonary disease.
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Affiliation(s)
| | | | - Ludwig Lin
- Stanford University, San Francisco, CA, USA
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