open access

Vol 50, No 3 (2018)
Original and clinical articles
Published online: 2018-06-22
Submitted: 2016-11-20
Accepted: 2018-05-25
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Risk factors for the development of Horner’s syndrome following interscalene brachial plexus block using ropivacaine for shoulder arthroscopy: a randomised trial

Michał Stasiowski, Marek Zuber, Radosław Marciniak, Michał Kolny, Ewa Chabierska, Przemysław Jałowiecki, Aleksandra Pluta, Anna Missir
DOI: 10.5603/AIT.a2018.0013
·
Pubmed: 29931665
·
Anaesthesiol Intensive Ther 2018;50(3):215-220.

open access

Vol 50, No 3 (2018)
Original and clinical articles
Published online: 2018-06-22
Submitted: 2016-11-20
Accepted: 2018-05-25

Abstract

Background: Horner’s syndrome is comprised of a set of symptoms caused by a permanent or transient ipsilateral
sympathetic trunk lesion or paralysis. It may occur after numerous pathologies in the cervical region, epidural, spinal
anaesthesia, and interscalene, transscalene, supraclavicular, or infraclavicular brachial plexus block. The aim of this
randomised, prospective clinical study was to evaluate the effect of the interscalene brachial plexus block (IBPB)
technique on the occurrence rate of Horner’s syndrome and identify contributing risk factors.

Methods: 108 randomly selected patients of ASA I-III status were scheduled for elective shoulder arthroscopy. The
patients received 20 mL of 0.5% ropivacaine either with ultrasound (US)-guided IBPB (U), peripheral nerve stimulation
(PNS)-confirmation IBPB (N), or US-guided, PNS-confirmed IBPB (dual guidance; NU).

Results: We observed that Horner’s syndrome developed in 12% of the N group, 6% of the NU group, and 9% of the
U group. The differences in the rates were not statistically significant (P = 0.616). Regardless of the technique used to
induce IBPB, our study did not demonstrate any particular anthropometric parameter that predisposed the patients
to the development of Horner’s syndrome. Interestingly, our results showed that NU patients with Horner’s syndrome
were significantly younger than NU patients without Horner’s syndrome.

Conclusion: The precision of IBPB by use of the dual guidance technique may reduce the rate of Horner’s syndrome.
The higher water concentration in the prevertebral spaces of younger patients may create better conditions for the
diffusion of ropivacaine, which may result in a statistically significant higher HS rate. 

Abstract

Background: Horner’s syndrome is comprised of a set of symptoms caused by a permanent or transient ipsilateral
sympathetic trunk lesion or paralysis. It may occur after numerous pathologies in the cervical region, epidural, spinal
anaesthesia, and interscalene, transscalene, supraclavicular, or infraclavicular brachial plexus block. The aim of this
randomised, prospective clinical study was to evaluate the effect of the interscalene brachial plexus block (IBPB)
technique on the occurrence rate of Horner’s syndrome and identify contributing risk factors.

Methods: 108 randomly selected patients of ASA I-III status were scheduled for elective shoulder arthroscopy. The
patients received 20 mL of 0.5% ropivacaine either with ultrasound (US)-guided IBPB (U), peripheral nerve stimulation
(PNS)-confirmation IBPB (N), or US-guided, PNS-confirmed IBPB (dual guidance; NU).

Results: We observed that Horner’s syndrome developed in 12% of the N group, 6% of the NU group, and 9% of the
U group. The differences in the rates were not statistically significant (P = 0.616). Regardless of the technique used to
induce IBPB, our study did not demonstrate any particular anthropometric parameter that predisposed the patients
to the development of Horner’s syndrome. Interestingly, our results showed that NU patients with Horner’s syndrome
were significantly younger than NU patients without Horner’s syndrome.

Conclusion: The precision of IBPB by use of the dual guidance technique may reduce the rate of Horner’s syndrome.
The higher water concentration in the prevertebral spaces of younger patients may create better conditions for the
diffusion of ropivacaine, which may result in a statistically significant higher HS rate. 

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Keywords

brachial plexus block, intrascalene; Horner’s syndrome; arthroscopy; local anaesthetics, ropivacaine

About this article
Title

Risk factors for the development of Horner’s syndrome following interscalene brachial plexus block using ropivacaine for shoulder arthroscopy: a randomised trial

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 50, No 3 (2018)

Pages

215-220

Published online

2018-06-22

DOI

10.5603/AIT.a2018.0013

Pubmed

29931665

Bibliographic record

Anaesthesiol Intensive Ther 2018;50(3):215-220.

Keywords

brachial plexus block
intrascalene
Horner’s syndrome
arthroscopy
local anaesthetics
ropivacaine

Authors

Michał Stasiowski
Marek Zuber
Radosław Marciniak
Michał Kolny
Ewa Chabierska
Przemysław Jałowiecki
Aleksandra Pluta
Anna Missir

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