open access

Vol 50, No 4 (2018)
Original and clinical articles
Published online: 2018-09-11
Submitted: 2017-01-31
Accepted: 2018-05-25
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Risk factors for occurrence of failed interscalene brachial plexus blocks for shoulder arthroscopy using 20 mL 0.5% ropivacaine: a randomised trial

Michał Jan Stasiowski, Ewa Chabierska, Radosław Marciniak, Michał Kolny, Marek Zuber, Przemysław Jałowiecki, Aleksandra Pluta, Izabela Szumera
DOI: 10.5603/AIT.a2018.0030
·
Pubmed: 30221338
·
Anaesthesiol Intensive Ther 2018;50(4):263-269.

open access

Vol 50, No 4 (2018)
Original and clinical articles
Published online: 2018-09-11
Submitted: 2017-01-31
Accepted: 2018-05-25

Abstract

Background: Adequate pain management after arthroscopic procedures improves patients’ satisfaction with the performed procedure, as well as facilitating early rehabilitation. The aim of the current randomised, prospective clinical study was to assess the influence of anthropometric parameters and the interscalene brachial plexus block (IBPB) technique on the quality of post-operational analgesia. Methods: 109 randomly selected patients of ASA I-III status were scheduled for elective shoulder arthroscopy. Reasons for non-inclusion were as follows: neurological deficit in the upper arm; allergies to amide Las; coagulopathy; and pregnancy. The patients received 20 mL of 0.5% ropivacaine for an ultrasound (US)-guided IBPB (group U), peripheral nerve stimulation (PNS)-confirmation IBPB (group N), or US-guided, PNS-confirmed IBPB (dual guidance; group NU). Results: We observed that the studied groups did not differ in mean time of sensory and motor block terminations and, surprisingly, in each group in individual cases the sensory block lasted up to 890-990 minutes providing satisfactory long-lasting post-operational analgesia in patients receiving IBPB. We observed a negative correlation between BMI and termination of the motor block and a positive correlation between age and termination of the sensory block in patients receiving US-guided IBPB (group U) in comparison with the two other groups. We found a positive correlation between the male gender and termination of the motor block in patients receiving PNS-guided IBPB (group N) in comparison with two other groups. Conclusion: In our study, patients received satisfactory analgesia in the post-operational period no matter what technique was used regardless of their age, gender or potentially uncommon anthropometry.

Abstract

Background: Adequate pain management after arthroscopic procedures improves patients’ satisfaction with the performed procedure, as well as facilitating early rehabilitation. The aim of the current randomised, prospective clinical study was to assess the influence of anthropometric parameters and the interscalene brachial plexus block (IBPB) technique on the quality of post-operational analgesia. Methods: 109 randomly selected patients of ASA I-III status were scheduled for elective shoulder arthroscopy. Reasons for non-inclusion were as follows: neurological deficit in the upper arm; allergies to amide Las; coagulopathy; and pregnancy. The patients received 20 mL of 0.5% ropivacaine for an ultrasound (US)-guided IBPB (group U), peripheral nerve stimulation (PNS)-confirmation IBPB (group N), or US-guided, PNS-confirmed IBPB (dual guidance; group NU). Results: We observed that the studied groups did not differ in mean time of sensory and motor block terminations and, surprisingly, in each group in individual cases the sensory block lasted up to 890-990 minutes providing satisfactory long-lasting post-operational analgesia in patients receiving IBPB. We observed a negative correlation between BMI and termination of the motor block and a positive correlation between age and termination of the sensory block in patients receiving US-guided IBPB (group U) in comparison with the two other groups. We found a positive correlation between the male gender and termination of the motor block in patients receiving PNS-guided IBPB (group N) in comparison with two other groups. Conclusion: In our study, patients received satisfactory analgesia in the post-operational period no matter what technique was used regardless of their age, gender or potentially uncommon anthropometry.
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Keywords

interscalene brachial plexus block, interscalene brachial plexus, local anesthetic, Lovett’s Rating Scale, ultrasound, peripheral nerve stimulator, body mass index, regional anesthesia, general anaesthes

About this article
Title

Risk factors for occurrence of failed interscalene brachial plexus blocks for shoulder arthroscopy using 20 mL 0.5% ropivacaine: a randomised trial

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 50, No 4 (2018)

Pages

263-269

Published online

2018-09-11

DOI

10.5603/AIT.a2018.0030

Pubmed

30221338

Bibliographic record

Anaesthesiol Intensive Ther 2018;50(4):263-269.

Keywords

interscalene brachial plexus block
interscalene brachial plexus
local anesthetic
Lovett’s Rating Scale
ultrasound
peripheral nerve stimulator
body mass index
regional anesthesia
general anaesthes

Authors

Michał Jan Stasiowski
Ewa Chabierska
Radosław Marciniak
Michał Kolny
Marek Zuber
Przemysław Jałowiecki
Aleksandra Pluta
Izabela Szumera

References (17)
  1. Falcão LFR, Perez MV, de Castro I, et al. Minimum effective volume of 0.5% bupivacaine with epinephrine in ultrasound-guided interscalene brachial plexus block. Br J Anaesth. 2013; 110(3): 450–455.
  2. Taboada M, Rodríguez J, Amor M, et al. Is ultrasound guidance superior to conventional nerve stimulation for coracoid infraclavicular brachial plexus block? Reg Anesth Pain Med. 2009; 34(4): 357–360.
  3. Takeda A, Ferraro LH, Rezende AH, et al. Minimum effective concentration of bupivacaine for axillary brachial plexus block guided by ultrasound. Braz J Anesthesiol. 2015; 65(3): 163–169.
  4. Avellanet M, Sala-Blanch X, Rodrigo L, et al. Permanent upper trunk plexopathy after interscalene brachial plexus block. J Clin Monit Comput. 2016; 30(1): 51–54.
  5. Baciarello M, Danelli G, Fanelli G. Real-time ultrasound visualization of intravascular injection of local anesthetic during a peripheral nerve block. Reg Anesth Pain Med. 2009; 34(3): 278–279.
  6. Gianesello L, Magherini M, Pavoni V, et al. The influence of interscalene block technique on adverse hemodynamic events. J Anesth. 2014; 28(3): 407–412.
  7. Lee JH, Cho SH, Kim SH, et al. Ropivacaine for ultrasound-guided interscalene block: 5 mL provides similar analgesia but less phrenic nerve paralysis than 10 mL. Can J Anaesth. 2011; 58(11): 1001–1006.
  8. Jariwala A, Pavan Kumar R, Coventry D. Sudden severe postoperative dyspnea following shoulder surgery: Remember inadvertent phrenic nerve block due to interscalene brachial plexus block. Int J Shoulder Surg. 2014; 8(2): 51–54.
  9. Kim JY, Song KS, Kim WJ, et al. Analgesic efficacy of two interscalene blocks and one cervical epidural block in arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc. 2016; 24(3): 931–939.
  10. Park SK, Choi YS, Choi SW, et al. A comparison of three methods for postoperative pain control in patients undergoing arthroscopic shoulder surgery. Korean J Pain. 2015; 28(1): 45–51.
  11. Nielsen KC, Guller U, Steele SM, et al. Influence of obesity on surgical regional anesthesia in the ambulatory setting: an analysis of 9,038 blocks. Anesthesiology. 2005; 102(1): 181–187.
  12. Carles M, Pulcini A, Macchi P, et al. An evaluation of the brachial plexus block at the humeral canal using a neurostimulator (1417 patients): the efficacy, safety, and predictive criteria of failure. Anesth Analg. 2001; 92(1): 194–198.
  13. Hanouz JL, Grandin W, Lesage A, et al. Multiple injection axillary brachial plexus block: influence of obesity on failure rate and incidence of acute complications. Anesth Analg. 2010; 111(1): 230–233.
  14. Koscielniak-Nielsen ZJ, Rotbøll-Nielsen P, Rassmussen H. Patients' experiences with multiple stimulation axillary block for fast-track ambulatory hand surgery. Acta Anaesthesiol Scand. 2002; 46(7): 789–793.
  15. Fuzier R, Lavidale M, Bataille B, et al. [Anxiety: an independent factor of axillary brachial plexus block failure?]. Ann Fr Anesth Reanim. 2010; 29(11): 776–781.
  16. Schwemmer U, Papenfuss T, Greim C, et al. Ultrasound-guided interscalene brachial plexus anaesthesia: differences in success between patients of normal and excessive weight. Ultraschall Med. 2006; 27(3): 245–250.
  17. Balcerkiewicz M, Wyrwiński M. Interakcje lekowe ropiwakainy. Terapia i Leki. Farm Pol. 2010; 66(6): 415–424.

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