open access

Vol 49, No 1 (2017)
Original and clinical articles
Published online: 2017-03-31
Submitted: 2016-11-20
Accepted: 2017-02-09
Get Citation

Randomized, comparative study of the effectiveness of three different techniques of interscalene brachial plexus block using 0.5% ropivacaine for shoulder arthroscopy

Michał Kolny, Michał J. Stasiowski, Marek Zuber, Radosław Marciniak, Ewa Chabierska, Aleksandra Pluta, Przemysław Jałowiecki, Tomasz Byrczek
DOI: 10.5603/AIT.2017.0009
·
Anaesthesiol Intensive Ther 2017;49(1):47-52.

open access

Vol 49, No 1 (2017)
Original and clinical articles
Published online: 2017-03-31
Submitted: 2016-11-20
Accepted: 2017-02-09

Abstract

BACKGROUND: Interscalene brachial plexus block is an effective regional anesthesia technique for shoulder surgeries. The superiority of the popular ultrasound-guided blocks over peripheral nerve stimulator-confirmed blocks remains unclear. In this study the efficacy of these different block techniques was compared.

METHODS: This prospective, randomized, clinical study included 109 patients (ASA grades I–III) who receive 20 mL 0.5% ropivacaine with ultrasound-guided blocks (U group), peripheral nerve stimulator-confirmed blocks (N group), or ultrasound-guided and peripheral nerve stimulator-confirmed blocks (dual guidance; NU group) for elective shoulder arthroscopy. Block onset time, duration, and effectiveness on the Lovett rating scale were assessed.

RESULTS: There was no statistically significant intergroup difference in duration of block performance, irrespective of the technique (P = 0.232). Onset time of complete warmth sensation loss (P < 0.001) and muscle strength abolition (P < 0.001) was significantly longer and mean Lovett rating scale score distribution was significantly higher in the N group than in the other groups (P < 0.001). These findings show a statistically significant correlation between the performance of the used block technique and the necessity of conversion to general anesthesia because of insufficient block in the N group (58.54%) than in the U (24.44%) and NU (19.57%) groups.

CONCLUSIONS: Peripheral nerve stimulator-confirmed needle placement is not necessary to ensure effectiveness of ultrasound-guided blocks, which is expressed as a lack of necessity of conversion to general anesthesia. Nevertheless, the dual guidance technique is recommended to reduce the risk of complications and might be considered the regional anesthesia of choice for shoulder surgery.

Abstract

BACKGROUND: Interscalene brachial plexus block is an effective regional anesthesia technique for shoulder surgeries. The superiority of the popular ultrasound-guided blocks over peripheral nerve stimulator-confirmed blocks remains unclear. In this study the efficacy of these different block techniques was compared.

METHODS: This prospective, randomized, clinical study included 109 patients (ASA grades I–III) who receive 20 mL 0.5% ropivacaine with ultrasound-guided blocks (U group), peripheral nerve stimulator-confirmed blocks (N group), or ultrasound-guided and peripheral nerve stimulator-confirmed blocks (dual guidance; NU group) for elective shoulder arthroscopy. Block onset time, duration, and effectiveness on the Lovett rating scale were assessed.

RESULTS: There was no statistically significant intergroup difference in duration of block performance, irrespective of the technique (P = 0.232). Onset time of complete warmth sensation loss (P < 0.001) and muscle strength abolition (P < 0.001) was significantly longer and mean Lovett rating scale score distribution was significantly higher in the N group than in the other groups (P < 0.001). These findings show a statistically significant correlation between the performance of the used block technique and the necessity of conversion to general anesthesia because of insufficient block in the N group (58.54%) than in the U (24.44%) and NU (19.57%) groups.

CONCLUSIONS: Peripheral nerve stimulator-confirmed needle placement is not necessary to ensure effectiveness of ultrasound-guided blocks, which is expressed as a lack of necessity of conversion to general anesthesia. Nevertheless, the dual guidance technique is recommended to reduce the risk of complications and might be considered the regional anesthesia of choice for shoulder surgery.

Get Citation

Keywords

brachial plexus; interscalene brachial plexus block; local anaesthetic; Lovett’s Rating Scale; ultrasound; peripheral nerve stimulator

About this article
Title

Randomized, comparative study of the effectiveness of three different techniques of interscalene brachial plexus block using 0.5% ropivacaine for shoulder arthroscopy

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 49, No 1 (2017)

Pages

47-52

Published online

2017-03-31

DOI

10.5603/AIT.2017.0009

Bibliographic record

Anaesthesiol Intensive Ther 2017;49(1):47-52.

Keywords

brachial plexus
interscalene brachial plexus block
local anaesthetic
Lovett’s Rating Scale
ultrasound
peripheral nerve stimulator

Authors

Michał Kolny
Michał J. Stasiowski
Marek Zuber
Radosław Marciniak
Ewa Chabierska
Aleksandra Pluta
Przemysław Jałowiecki
Tomasz Byrczek

Important: This website uses cookies.tanya dokter More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

VM Media sp. z o.o. VM Group sp.k., Grupa Via Medica, Świętokrzyska 73 St., 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl