scholarly journals Effectiveness of combined suprascapular nerve and costoclavicular brachial plexus block for arthroscopic shoulder surgery: a prospective observational study

2019 ◽  
Author(s):  
Byung-Gun Kim ◽  
Woojoo Lee ◽  
Hyunzu Kim ◽  
Chunwoo Yang ◽  
Yoon Sang Jeon ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Nerve Palsy ◽  
Brachial Plexus Block ◽  
Suprascapular Nerve ◽  
Shoulder Surgery ◽  
Phrenic Nerve Palsy ◽  
Interscalene Brachial Plexus Block ◽  
Arthroscopic Shoulder Surgery ◽  
Plexus Block

Abstract Background Although interscalene brachial plexus block provides effective anesthesia and analgesia for shoulder surgery, one major drawback of interscalene brachial plexus block is ipsilateral phrenic nerve palsy. Several diaphragm-sparing nerve blocks have been suggested. We prospectively evaluated the effectiveness of combined suprascapular nerve and costoclavicular brachial plexus block for postoperative analgesia following arthroscopic shoulder surgery.Methods Nineteen patients scheduled for arthroscopic shoulder surgery received combined ultrasound-guided suprascapular nerve and costoclavicular brachial plexus block. Pain scores, use of supplemental analgesia, incidence of phrenic nerve palsy, block-related outcomes, patient satisfaction, and adverse effects were assessed.Results The block was successful in 17 patients (89.5%). Postoperative pain control was effective during the first 24 h after surgery. Phrenic nerve palsy did not occur (0%, 95% confidential interval 0 – 17%). There were no severe adverse events. Patients reported a high degree of satisfaction.Conclusion Combined suprascapular nerve and costoclavicular brachial plexus block provided effective postoperative analgesia for arthroscopic shoulder surgery without causing phrenic nerve palsy.

Superior Trunk Block Provides Noninferior Analgesia Compared with Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery

2019 ◽  
Vol 131 (6) ◽  
pp. 1316-1326 ◽  
Author(s):  
RyungA Kang ◽  
Ji Seon Jeong ◽  
Ki Jinn Chin ◽  
Jae Chul Yoo ◽  
Jong Hwan Lee ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Postoperative Analgesia ◽  
Brachial Plexus Block ◽  
Group Versus ◽  
Shoulder Surgery ◽  
Interscalene Block ◽  
Block Group ◽  
Interscalene Brachial Plexus Block ◽  
Arthroscopic Shoulder Surgery ◽  
Plexus Block

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Interscalene brachial plexus block of the C5–C6 roots provides highly effective postoperative analgesia after shoulder surgery but usually results in hemidiaphragmatic paresis. Injection around the superior trunk of the brachial plexus is an alternative technique that may reduce this risk. The authors hypothesized that the superior trunk block would provide noninferior postoperative analgesia compared with the interscalene block and reduce hemidiaphragmatic paresis. Methods Eighty patients undergoing arthroscopic shoulder surgery were randomized to receive a preoperative injection of 15 ml of 0.5% ropivacaine and 5 μg · ml−1 epinephrine around either (1) the C5–C6 nerve roots (interscalene block group) or (2) the superior trunk (superior trunk block group). The primary outcome was pain intensity 24 h after surgery measured on an 11-point numerical rating score; the prespecified noninferiority limit was 1. Diaphragmatic function was assessed using both ultrasonographic measurement of excursion and incentive spirometry by a blinded investigator before and 30 min after block completion. Results Seventy-eight patients completed the study. The pain score 24 h postoperatively (means ± SDs) was 1.4 ± 1.0 versus 1.2 ± 1.0 in the superior trunk block (n = 38) and interscalene block (n = 40) groups, respectively. The mean difference in pain scores was 0.1 (95% CI, −0.3 to 0.6), and the upper limit of the 95% CI was lower than the prespecified noninferiority limit. Analgesic requirements and all other pain measurements were similar between groups. Hemidiaphragmatic paresis was observed in 97.5% of the interscalene block group versus 76.3% of the superior trunk block group (P = 0.006); paresis was complete in 72.5% versus 5.3% of the patients, respectively. The decrease in spirometry values from baseline was significantly greater in the interscalene block group. Conclusions The superior trunk block provided noninferior analgesia compared with interscalene brachial plexus block for up to 24 h after arthroscopic shoulder surgery and resulted in significantly less hemidiaphragmatic paresis.

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