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Abe S, Kondo H, Tomiyama Y, Shimada T, Bun M, Kuriyama K. Risk factors for insufficient ultrasound-guided supraclavicular brachial plexus block. J Exp Orthop 2023; 10:48. [PMID: 37079142 PMCID: PMC10119333 DOI: 10.1186/s40634-023-00611-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/06/2023] [Indexed: 04/21/2023] Open
Abstract
PURPOSE Ultrasound-guided supraclavicular brachial plexus block (SCBPB) is performed by surgeons for upper limb anesthesia; however, certain patients need additional local anesthesia. This study aimed to identify risk factors for additional local anesthetic injection requirements. METHODS In total, 269 patients receiving ultrasound-guided SCBPB were enrolled. Patient age, sex, body mass index, anesthetic drug dose, surgeon expertise (hand surgeon or resident), tourniquet time, comorbidities (diabetes mellitus and mental disorders), and preoperative blood pressure representing anxiety were compared between the additional local anesthesia and no additional local anesthesia groups matched for background using propensity scores. Receiver operating characteristic analysis was performed to determine risk factor cut-off values with the highest predictive potential. RESULTS Of 269 patients, 41 (15.2%) required additional intraoperative local anesthesia. Among surgical sites, elbow surgery showed the highest prevalence of the need for additional local anesthesia (17/41, 41%). A high body mass index and high systolic blood pressure before surgery were identified as risk factors for additional intraoperative local anesthesia requirement. Furthermore, systolic blood pressure > 170 mmHg (area under the curve, 0.66) predicted the need for intraoperative local anesthesia with 36% sensitivity, 89% specificity, 37.5% positive predictive value, and 88.6% negative predictive value. The median systolic blood pressure was significantly greater in patients requiring additional local anesthesia than in those not requiring it [151 (139-171) mmHg vs. 145 (127-155) mmHg; P = 0.026]. CONCLUSION Elbow surgery, obesity, and high systolic blood pressure (> 170 mmHg) before surgery are predictive of additional intraoperative local anesthesia requirement. LEVEL OF EVIDENCE Prognostic Level III.
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Affiliation(s)
- Shingo Abe
- Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan.
| | - Hiroki Kondo
- Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Yohei Tomiyama
- Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Toshiki Shimada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masayuki Bun
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kohji Kuriyama
- Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
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Regional anaesthesia for surgical repair of proximal humerus fractures: a systematic review and critical appraisal. Arch Orthop Trauma Surg 2019; 139:1731-1741. [PMID: 31392408 DOI: 10.1007/s00402-019-03253-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Regional anaesthesia (RA) is often used in shoulder surgery because it provides adequate postoperative analgesia and may enhance the patient outcome. RA reduces overall opioid consumption and is frequently used in enhanced recovery programs to decrease hospital stay. However, there is very limited literature confirming these advantages in the surgical repair of proximal humerus fractures. This paper reviews the current literature on the use of RA in pain management after surgical repair of these fractures and evaluates the effect of RA on the functional outcome, length of stay in hospital, and health care expenditure. MATERIALS AND METHODS The PubMed, Embase, Web of Science, and Cochrane Library databases were searched up to March 1, 2018. Studies investigating the use of RA in the management of proximal humerus fractures were included. RESULTS Eleven studies (containing 1872 patients) were eligible for inclusion. The analgesic effect of RA was investigated in eight studies that confirmed its pain-relieving ability. Two studies measured functionality and length of hospitalization and suggested that RA improved function and shortened the stay in hospital. Nine papers mentioned side effects associated with RA while three articles claim that RA decreases the incidence of adverse events associated with general anaesthesia. CONCLUSIONS This systematic review suggests that RA is a good option for postoperative analgesia in patients undergoing surgical repair of a proximal humerus fracture and is associated with fewer adverse events, a shorter recovery time, and a better functional outcome than those achieved by general anaesthesia alone. However, given the limited amount of data available, conclusions need to be made with caution and prospective studies are needed in the future.
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Murphy GS, Greenberg SB, Szokol JW. Safety of Beach Chair Position Shoulder Surgery. Anesth Analg 2019; 129:101-118. [DOI: 10.1213/ane.0000000000004133] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Haršanji Drenjančević I, Drenjančević D, Davidović-Cvetko E, Drenjančević I, Gulam D, Kvolik S. DOES THE ANESTHESIA TECHNIQUE AFFECT ARTERIAL PRESSURE AND REGIONAL CEREBRAL OXYGEN SATURATION DURING SHOULDER ARTHROSCOPY IN THE BEACH CHAIR POSITION? Acta Clin Croat 2018; 57:473-479. [PMID: 31168180 PMCID: PMC6536278 DOI: 10.20471/acc.2018.57.03.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
- This study aimed to investigate the impact of posture and anesthesia techniques on blood pressure changes, heart rate and regional cerebral oxygen saturation during shoulder arthroscopy in the beach chair position (BCP). Sixty patients were included in this prospective cohort study: 30 patients mechanically ventilated and subjected to general anesthesia (GA) and 30 patients subjected to interscalene block (ISB) without mechanical ventilation. Noninvasive blood pressure, heart rate (HR), peripheral blood oxygen saturation and regional oxygen saturation of the brain were measured in twelve predefined points during perioperative period. The GA group patients had significantly lower mean arterial pressure and heart rate values compared to patients in ISB group during BCP (p<0.001). There was a significant difference in regional cerebral saturation between the groups measured only in points of induction and emergence from anesthesia in favor of GA group when receiving 100% oxygen (p<0.001). Changes in the mean arterial pressure and regional cerebral oxygen saturation for both brain hemispheres correlated only at the 10th minute after setting up BCP in GA patients (right, p=0.004 and left, p=0.003). This correlation did not exist in the ISB group patients at any of the points measured. Cerebral desaturation events recorded in both groups were not statistically significantly different. Results of this study demonstrated that GA preserved regional cerebral oxygenation in a safe range during BCP despite changes in the arterial blood pressure and heart rate in comparison to ISB.
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Affiliation(s)
| | - Domagoj Drenjančević
- 1Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek University Hospital Centre and Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Transfusion Medicine, Osijek University Hospital Centre and Department of Microbiology and Parasitology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Lavoslav Ružička College of Applied Sciences of Vukovar, Vukovar, Croatia; 4Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Anesthesiology, Resuscitation and Intensive Medicine, Split University Hospital Centre, Split, Croatia
| | - Erna Davidović-Cvetko
- 1Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek University Hospital Centre and Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Transfusion Medicine, Osijek University Hospital Centre and Department of Microbiology and Parasitology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Lavoslav Ružička College of Applied Sciences of Vukovar, Vukovar, Croatia; 4Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Anesthesiology, Resuscitation and Intensive Medicine, Split University Hospital Centre, Split, Croatia
| | - Ines Drenjančević
- 1Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek University Hospital Centre and Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Transfusion Medicine, Osijek University Hospital Centre and Department of Microbiology and Parasitology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Lavoslav Ružička College of Applied Sciences of Vukovar, Vukovar, Croatia; 4Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Anesthesiology, Resuscitation and Intensive Medicine, Split University Hospital Centre, Split, Croatia
| | - Danijela Gulam
- 1Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek University Hospital Centre and Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Transfusion Medicine, Osijek University Hospital Centre and Department of Microbiology and Parasitology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Lavoslav Ružička College of Applied Sciences of Vukovar, Vukovar, Croatia; 4Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Anesthesiology, Resuscitation and Intensive Medicine, Split University Hospital Centre, Split, Croatia
| | - Slavica Kvolik
- 1Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek University Hospital Centre and Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Transfusion Medicine, Osijek University Hospital Centre and Department of Microbiology and Parasitology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Lavoslav Ružička College of Applied Sciences of Vukovar, Vukovar, Croatia; 4Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Anesthesiology, Resuscitation and Intensive Medicine, Split University Hospital Centre, Split, Croatia
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Ghodki PS, Singh ND. Incidence of hemidiaphragmatic paresis after peripheral nerve stimulator versus ultrasound guided interscalene brachial plexus block. J Anaesthesiol Clin Pharmacol 2016; 32:177-81. [PMID: 27275045 PMCID: PMC4874070 DOI: 10.4103/0970-9185.168263] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Aims: We compared interscalene brachial plexus block (ISBPB) using peripheral nerve stimulation (PNS) and ultrasound (US) techniques. The primary outcomes were the incidence of hemidiaphragmatic paresis (HDP) and the duration of the block. Secondary outcomes were the block success rate, time to conduct the block, onset of sensory block, and dermatomal spread, postoperative pain by Numeric Rating Scale (NRS), duration of postoperative analgesia and incidence of complications. Material and Methods: We conducted a prospective, randomized, and observer-blinded study in 60 patients undergoing shoulder arthroscopy under block plus general anesthesia. ISBPB was performed with 10 ml of 0.5% bupivacaine using either PNS (Group PNS, n = 30) or US (Group US, n = 30). Hemidiaphragmatic function, the primary outcome, was assessed by ultrasonographic evaluation of diaphragmatic movement and pulmonary function tests using a bedside spirometer (forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate). General anesthesia was administered to all the patients for surgery. P < 0.05 test was considered to be statistically significant. Results: Twelve patients in Group PNS had HDP and none in Group US (P < 0.0001). PFTs were also significantly reduced in Group PNS (P < 0.0001). The time to conduct the block and sensory onset time both were less in Group US (P < 0.05). The groups did not differ in block success rate, duration of analgesia, and NRS. Other complications like incidence of Horner's syndrome and vascular puncture were comparable in both the groups. Conclusions: PNS guided ISBPB with 10 ml of 0.5% bupivacaine is associated with a higher incidence of HDP as compared to US guided ISBPB. There is no significant difference in quality or duration of analgesia in the two groups.
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Affiliation(s)
- Poonam Sachin Ghodki
- Department of Anesthesiology, Shrimati Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Noopur Dasmit Singh
- Department of Anesthesiology, Shrimati Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
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Ozturk L, Kesimci E, Albayrak T, Kanbak O. Bispectral index-guided general anaesthesia in combination with interscalene block reduces desflurane consumption in arthroscopic shoulder surgery: a clinical comparison of bupivacaine versus levobupivacaine. BMC Anesthesiol 2015; 15:104. [PMID: 26194656 PMCID: PMC4508821 DOI: 10.1186/s12871-015-0087-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 07/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goal of this study was to compare the influence of an interscalene brachial plexus block (ISB) performed with either bupivacaine or levobupivacaine in conjunction with general anaesthesia (GA) on desflurane consumption, which was titrated to maintain the recovery profiles and postoperative analgesia while also keeping the bispectral index score (BIS) between 40 and 60 in patients undergoing arthroscopic shoulder surgery. METHODS Sixty patients undergoing arthroscopic shoulder surgery were prospectively randomized to receive GA with desflurane alone (group C) or in combination with a preoperative ISB by either bupivacaine 0.25 % (group B) 40 ml or levobupivacaine 0.25 % (group L) 40 ml. BIS scores or respiratory and hemodynamic parameters during the operation, recovery characteristics, consumed doses of desflurane and pain intensities were evaluated. RESULTS The eye opening time was 4.0 ± 2.5 minutes for group B, 4.6 ± 2.4 minutes for group L, and 6.2 ± 2.1 minutes for group C (p < 0.05). Group B and group L saved 36 % and 25 % desflurane per unit time respectively when compared with group C (p < 0.001and p < 0.05) while the mean pain scores and analgesic requirements the first day after surgery were higher in group C (p < 0.05). CONCLUSIONS Because of lower desflurane consumption, a superior recovery profile, and a high degree of patient acceptance, general anaesthesia in combination with interscalene block may be preferred in arthroscopic shoulder surgery. TRIAL REGISTRATION The trial registration number is ACTRN12613000381785.
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Affiliation(s)
- Levent Ozturk
- Department of Anaesthesiology and Reanimation, Yıldırım Beyazıt University Ataturk Training and Research Hospital, Bilkent, Ankara, 06800, Turkey.
| | - Elvin Kesimci
- Anaesthesiology and Intensive Care Department, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Tuna Albayrak
- Anaesthesiology and Intensive Care Department, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Orhan Kanbak
- Anaesthesiology and Intensive Care Department, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
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Janssen H, Stosch RV, Pöschl R, Büttner B, Bauer M, Hinz JM, Bergmann I. Blood pressure response to combined general anaesthesia/interscalene brachial plexus block for outpatient shoulder arthroscopy. BMC Anesthesiol 2014; 14:50. [PMID: 25002832 PMCID: PMC4083130 DOI: 10.1186/1471-2253-14-50] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 06/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Shoulder surgery is often performed in the beach-chair position, a position associated with arterial hypotension and subsequent risk of cerebral ischaemia. It can be performed under general anaesthesia or with an interscalene brachial plexus block, each of which has specific advantages but also specific negative effects on blood pressure control. It would be worthwhile to combine the advantages of the two, but the effects of the combination on the circulation are not well investigated. We studied blood pressure, heart rate, and incidence of adverse circulatory events in patients undergoing shoulder surgery in general anaesthesia with or without an interscalene block. METHODS Prospective, randomised, blinded study in outpatients (age 18 to 80 years) undergoing shoulder arthroscopy. General anaesthesia was with propofol/opioid, interscalene block with 40 ml 1% mepivacaine. Hypotension requiring treatment was defined as a mean arterial pressure <60 mmHg or a systolic pressure <80% of baseline; relevant bradycardia was a heart rate <50 bpm with a decrease in blood pressure. RESULTS Forty-two patients had general anaesthesia alone, 41 had general anaesthesia plus interscalene block. The average systolic blood pressure under anaesthesia in the beach-chair position was 114 ± 7.3 vs. 116 ± 8.3 mmHg (p = 0.09; all comparisons General vs. General-Regional). The incidence of a mean arterial pressure under 60 mmHg or a decrease in systolic pressure of more than 20% from baseline was 64% vs. 76% (p = 0.45). The number of patients with a heart rate lower than 50 and a concomitant blood pressure decrease was 8 vs. 5 (p = 0.30). CONCLUSION One can safely combine interscalene block with general anaesthesia for surgery in the beach-chair position in ASA I and II patients. CLINICAL TRIAL NUMBER DRKS00005295.
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Affiliation(s)
- Hauke Janssen
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Robert-Koch Str. 40, Göttingen 37075, Germany
| | | | - Rupert Pöschl
- Anaesthesia Clinic for Outpatient Surgery, Baunatal, Germany
| | - Benedikt Büttner
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Robert-Koch Str. 40, Göttingen 37075, Germany
| | - Martin Bauer
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Robert-Koch Str. 40, Göttingen 37075, Germany
| | - José Maria Hinz
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Robert-Koch Str. 40, Göttingen 37075, Germany
| | - Ingo Bergmann
- Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Robert-Koch Str. 40, Göttingen 37075, Germany
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Villevieille T, Delaunay L, Gentili M, Benhamou D. Chirurgie arthroscopique de l’épaule et complications ischémiques cérébrales. ACTA ACUST UNITED AC 2012; 31:914-8. [DOI: 10.1016/j.annfar.2012.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 08/14/2012] [Indexed: 10/27/2022]
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