Single-shot Interscalene Brachial Plexus Block Research Articles

Evaluation of the Effect of Interscalene Brachial Plexus Block on Intracranial Pressure Using Optic Nerve Sheath Diameter and Internal Jugular vein Collapsibility Index.

To determine the effect of single-shot interscalene brachial plexus (ISBP) block on intracranial pressure (ICP) by evaluating the extravascular volume effect of the medicine on the internal jugular vein (IJV). Interventional study. Department of Anaesthesiology and Reanimation, Sivas Cumhuriyet University, Sivas, Turkey, from January to June 2022. Thirty-four patients were included in this prospective clinical study. All patients had single-shot ISBP block with 25 ml of local anaesthetic. Optic nerve sheath diameter (ONSD), maximum (Dmax) and minimum (Dmin) diameters of IJV and IJV collapsibility index (IJV-CI) were recorded before the block (basal), 20 minutes, and 60 minutes after the block. Twenty-nine patients had higher ONSD values at 60th minute compared to their basal values. There were negative correlations between the changes of ONSD and IJVCI (r=0.616, p<0.001) and ONSD and Dmax (r=0.581, p<0.001) in time period between basal and 20th minute. There were negative correlations between the changes of ONSD and IJVCI (r=0.518, p=0.002), ONSD and Dmax (r=0.664, p<0.001) in time period between basal and 60th minute. Single-shot ISBP block with 25 ml of local anaesthetic may be a factor that increases ICP. Repeated intraoperative ONSD measurements are recommended in patients operated with ISBP block. Interscalene Brachial Plexus Block, Intracranial pressure, Optic nerve sheath diameter, Internal jugular vein collapsibility index.

This Month in Anesthesiology

This Month in Anesthesiology

Perioperative Oral Pregabalin Results in Postoperative Pain Scores Equivalent to Those of Interscalene Brachial Plexus Block After Arthroscopic Rotator Cuff Repair: A Randomized Clinical Trial

To compare the analgesic effects of pregabalin to those of single-shot interscalene brachial plexus block (ISBPB) in adults having arthroscopic rotator cuff (RC) repair, as well as ISBPB's effect on postoperative opioid consumption, patient satisfaction, and opioid-related adverse effects. In this randomized trial, 79 adults having arthroscopic RC repair were randomized to receive perioperative oral pregabalin (Lyrica, twice daily starting the evening before surgery, for a total of 4 doses) or single-shot ISBPB (20 ml of bupivacaine 0.25%). Intra- and postoperative management was standardized. The primary outcome was median self-reported pain score (on a visual analog scale of 0 to 100) at rest during the initial 10 postoperative days. Other outcomes included pain during activity, postoperative opioid consumption, opioid-related adverse effects, quality of recovery, and pain satisfaction score. Of 71 eligible patients, 59 were analyzed, of whom 29 received pregabalin and 30 received ISBPB. Groups were similar regarding demographic, baseline, and intraoperative variables. Median pain score at rest over the 10 postoperative days was 51 (interquartile range 26, 76) in the pregabalin group and 52 (22, 74) in the ISBPB group (difference 0.5 points; 95% confidence interval [CI] -3.2 to 6.3; P= .53). Opioid consumption during the initial 10 postoperative days was also similar (difference in median 90 mg of morphine equivalents; 95% CI -32 to 177.5; P= .12). No differences were found in any other outcome. Perioperative use of pregabalin in adults undergoing arthroscopic RC repair provided analgesia comparable to that of ISBPB for 10 days after surgery. II, randomized controlled trial (high dropout rate).

Continuous suprascapular nerve block compared with single-shot interscalene brachial plexus block for pain control after arthroscopic rotator cuff repair

OBJECTIVES:We compared the analgesic efficacy of a continuous suprascapular nerve block (C-SSNB) and a single-shot interscalene brachial plexus block (S-ISNB) for postoperative pain management in patients undergoing arthroscopic rotator cuff repair.METHODS:A total of 118 patients undergoing arthroscopic rotator cuff repair were randomly allocated to the S-ISNB or C-SSNB groups. Postoperative pain was assessed using the visual analog scale (VAS) at 1, 2, 6, 12, and 24 h postoperatively. Supplemental analgesic use was recorded as total equianalgesic fentanyl consumption.RESULTS:The C-SSNB group showed significantly higher VAS scores at 0−1 h and 1−2 h after the surgery than the S-ISNB group (4.9±2.2 versus 2.3±2.2; p<0.0001 and 4.8±2.1 versus 2.4±2.3; p<0.0001, respectively). The C-SSNB group showed significantly lower VAS scores at 6−12 h after the surgery than the S-ISNB group (4.1±1.8 versus. 5.0±2.5; p=0.031). The C-SSNB group required significantly higher doses of total equianalgesic fentanyl in the post-anesthesia care unit than the S-ISNB group (53.66±44.95 versus 5.93±18.25; p<0.0001). Total equianalgesic fentanyl in the ward and total equianalgesic fentanyl throughout the hospital period were similar between the groups (145.99±152.60 versus 206.13±178.79; p=0.052 and 199.72±165.50 versus 212.15±180.09; p=0.697, respectively)CONCLUSION:C-SSNB was more effective than S-ISNB at 6−12 h after the surgery for postoperative analgesia after arthroscopic rotator cuff repair.

Improvement in postoperative pain control by combined use of intravenous dexamethasone with intravenous dexmedetomidine after interscalene brachial plexus block for arthroscopic shoulder surgery: A randomised controlled trial.

Intravenous dexamethasone or dexmedetomidine is reported to prolong the duration of analgesia after single-shot interscalene brachial plexus block (ISBPB). However, the effect of co-administration of these agents on the duration of analgesia has not been evaluated. We evaluated the difference in time to first rescue analgesic request between patients receiving co-administered intravenous dexamethasone and dexmedetomidine and patients receiving intravenous dexamethasone alone after single-shot ISBPB for arthroscopic shoulder surgery. A randomised controlled study. A single tertiary care centre, study period from August 2017 to January 2018. Sixty-six patients undergoing arthroscopic shoulder surgery with ISBPB with 15 ml of 0.5% ropivacaine with 1 : 200 000 epinephrine. We randomly assigned the patients to one of three groups: intravenous 0.9% saline (control), intravenous dexamethasone 0.11 mg kg (D1 group), or co-administered intravenous dexamethasone 0.11 mg kg and intravenous dexmedetomidine 1.0 μg kg (D2 group). The primary outcome was the time to first rescue analgesic request. The median [interquartile range] time to first rescue analgesic request was significantly longer for the D2 group (66.3 h [23.3 to 72]) than the D1 (17.4 h [14.9 to 36], P = 0.002) and control (10.9 h [10.1 to 12.2], P < 0.001) groups. The D1 and D2 groups both had reduced pain scores, reduced postoperative opioid consumption, less sleep disruption and improved patient satisfaction compared with the control group. There were no significant elevations in blood glucose concentrations in patients receiving dexamethasone (D1 and D2 groups) compared with the control group at postoperative day 1. Co-administration of intravenous dexamethasone (0.11 mg kg) with dexmedetomidine (1.0 μg kg) significantly prolonged the time to first rescue analgesic request after single-shot ISBPB in patients undergoing arthroscopic shoulder surgery. Clinical Trial Registry of Korea; https://cris.nih.go.kr/cris/index.jsp and identifier: KCT0002569.

Effective Dose of Intravenous Dexmedetomidine to Prolong the Analgesic Duration of Interscalene Brachial Plexus Block: A Single-Center, Prospective, Double-Blind, Randomized Controlled Trial.

Intravenous (IV) dexmedetomidine (DEX) is reported to prolong the analgesic duration after single-shot interscalene brachial plexus block (ISBPB). However, the effective analgesic dose of IV DEX remains undetermined. Therefore, we aimed to elucidate the clinically relevant dose of IV DEX to prolong the analgesic duration of ISBPB. Seventy-two patients scheduled for arthroscopic shoulder surgery received ISBPB with 15 mL of 0.5% ropivacaine with 1:200,000 epinephrine and were randomly assigned to 1 of 4 groups (n = 18, each): (1) IV normal saline (control), (2) IV DEX 0.5 μg/kg (DEX 0.5), (3) IV DEX 1.0 μg/kg (DEX 1.0), and (4) IV DEX 2.0 μg/kg (DEX 2.0). The primary outcome was time to the first pain at surgical site. The median (interquartile range) duration of analgesia was significantly prolonged for the DEX 2.0 (874 minutes [727-1153 minutes]) compared with 656 minutes (590-751 minutes), 703 minutes (644-761 minutes), and 696 minutes (615-814 minutes) for the control, DEX 0.5 and DEX 1.0 groups, respectively (P = 0.001, P = 0.008, and P = 0.003, respectively). Postoperative cumulative IV morphine equivalent consumption at 24 hours was significantly lower in the DEX 2.0 compared with the control, DEX 0.5 and DEX 1.0 groups (P < 0.001, P < 0.001, and P = 0.007, respectively). There were no significant differences in the incidence of intraoperative hypotension and the number of patients who required ephedrine after the pairwise group analysis. Also, there were no significant differences on the durations of motor blockade and sedation and the incidence of bradycardia. Intravenous DEX at a dose of 2.0 μg/kg significantly increased the duration of ISBPB analgesia without prolonging motor blockade and reduced the cumulative opioid consumption at the first 24 hours in patients undergoing arthroscopic shoulder surgery. This study was registered at the Clinical Trial Registry of Korea, identifier KCT0002119.

Dose-dependency of dexamethasone on the analgesic effect of interscalene block for arthroscopic shoulder surgery using ropivacaine 0.5%: A randomised controlled trial.

Dexamethasone prolongs the duration of single-shot interscalene brachial plexus block (SISB). However, dose-dependency of dexamethasone as an adjuvant for SISB remains insufficiently understood. The objective of this study is to evaluate the effect of different doses of dexamethasone on the duration of SISB using ropivacaine 0.5%. A randomised, double-blind controlled trial. Single university tertiary care centre. One hundred and forty-four patients scheduled for elective arthroscopic shoulder surgery were allocated randomly to one of four groups. Patients received 12 ml of ropivacaine 0.5% in 0.9% saline (control group), or containing dexamethasone 2.5, 5.0 or 7.5 mg for SISB. The primary endpoint was the time to the first analgesic request. Pain scores and adverse effects were also assessed up to 48 h postoperatively. Inclusion of dexamethasone 2.5, 5.0 and 7.5 mg resulted in significant (P < 0.001) increases in time to the first analgesic request by factors of 1.6, 2.2 and 1.8, respectively. The percentages of patients not requiring analgesics in the first 48 h postoperatively with dexamethasone 0.0, 2.5, 5.0 and 7.5 mg were 3, 22, 39 and 33%, respectively (P < 0.001). There were no significant effects on pain scores or incidences of adverse effects. Dexamethasone demonstrated significant beneficial dose-dependent effects on duration to the first analgesic request, the number of patients not requiring analgesics and analgesic use in the first 48 h after SISB for arthroscopic shoulder surgery. There were no significant effects on pain scores or incidences of adverse effects. the trial was registered with the Clinical Trial Registry of Korea: https://cris.nih.go.kr/cris/index.jsp. Identifier: KCT0001078.

Perineural but not systemic low-dose dexamethasone prolongs the duration of interscalene block with ropivacaine: a prospective randomized trial

PurposeTo determine the effects of intravenous and perineural dexamethasone on the duration of interscalene brachial plexus block (ISB) with ropivacaine in patients undergoing arthroscopic shoulder surgery.Patients and methodsIn this prospective, randomized, placebo-controlled trial, patients presenting for arthroscopic shoulder surgery with an ISB were randomized to receive ropivacaine 0.75% (group C), ropivacaine 0.75% plus perineural dexamethasone 4 mg (group Dperi), or ropivacaine 0.75% plus intravenous dexamethasone 4 mg (group Div). The primary outcome was the duration of analgesia, defined as the time between performance of the block and the first request for analgesic.ResultsThirty-nine patients were randomized. The median times of sensory block in groups C, Dperi, and Div were 11.2 hours (interquartile range [IQR] 8.0–15.0 hours), 18.0 hours (IQR 14.5–19.0 hours), and 14.0 hours (IQR 12.7–15.1 hours), respectively. Significant differences were observed between groups Dperi and C (P=0.001). Kaplan–Meier analysis for the first analgesic request showed significant differences between groups Dperi and C (P=0.005) and between groups Dperi and Div (P=0.008), but not between groups C and Div.ConclusionPerineural but not intravenous administration of 4 mg of dexamethasone significantly prolongs the duration of effective postoperative analgesia resulting from a single-shot ISB with ropivacaine 0.75%.

I.V. and Perineural Dexamethasone are Equivalent in Increasing the Analgesic Duration of a Single-Shot Interscalene Block With Ropivacaine for Shoulder Surgery

Desmet, M.*; Braems, H.†; Reynvoet, M.*; Plasschaert, S.*; van Cauwelaert, J.‡; Pottel, H.§; Carlier, S.*; Missant, C.†; van de Velde, M.† Author Information

Analgesia requirements after interscalene block for shoulder arthroscopy: the 5 days following surgery

Excellent initial post-operative analgesia for patients undergoing arthroscopic shoulder surgery can be provided with a single-shot interscalene brachial plexus block. However there have been concerns that when the block wears off, patients may experience pain and this may occur at home. Some investigators have advocated the use of continuous ambulatory local anaesthetic infusions following hospital discharge. We prospectively studied pain scores, analgesic requirements and satisfaction of patients at home in the first 5 days following arthroscopic shoulder surgery to see whether continuous infusion would be of benefit. Fifteen percent of patients experienced severe pain at some time over the first 3 days, and this percentage decreased to 7% by day 5. However 97% of our patients were satisfied with their post-operative oral analgesia management and less than 5% contacted their GP for further analgesia issues. Over 80% of our patients required only simple analgesics following hospital discharge. Post-operative continuous ambulatory local anaesthetic infusions may not be justified following this intermediate magnitude of surgery.