Differential lung ventilation assessed by electrical impedance tomography in ultrasound-guided anterior suprascapular nerve block vs. interscalene brachial plexus block
| Autor: | Peter Salz, Virginia Pech, Julia Mrongowius, Andreas W. Reske, David Petroff, Martin Wiegel |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Shoulder
Shoulder surgery medicine.medical_treatment Diaphragmatic breathing law.invention Arthroscopy 03 medical and health sciences 0302 clinical medicine Patient satisfaction Randomized controlled trial 030202 anesthesiology law Hand strength Electric Impedance Clinical endpoint medicine Humans Anesthetics Local Lung Tomography Ultrasonography Interventional Brachial plexus block Pain Postoperative business.industry Ropivacaine 030208 emergency & critical care medicine Brachial Plexus Block Anesthesiology and Pain Medicine Anesthesia business medicine.drug |
| Zdroj: | European Journal of Anaesthesiology. 37:1105-1114 |
| ISSN: | 1365-2346 0265-0215 |
| DOI: | 10.1097/eja.0000000000001367 |
| Popis: | BACKGROUND Ultrasound-guided interscalene brachial plexus block (ISB) is used to control pain after shoulder surgery. Though effective, drawbacks include phrenic nerve block and motor block of the hand. The ultrasound-guided anterior approach to perform suprascapular nerve block (SSNB) may provide a good alternative. OBJECTIVE To compare lung ventilation and diaphragmatic activity on the operated side in ISB and SSNB. DESIGN Randomised, controlled patient-blinded and assessor-blinded trial. SETTING Outpatient surgical clinic with recruitment from June 2017 to January 2018. PATIENTS Fifty-five outpatients scheduled for arthroscopic shoulder surgery were allocated randomly to receive SSNB or ISB. Technical problems with monitoring devices unrelated to the intervention led to exclusion of seven patients. The remaining 48 (n=24 in each group) were followed up for 24 h without drop-outs. INTERVENTIONS Patients received 10 ml of ropivacaine 1.0% wt/vol for both procedures. OUTCOME MEASURES Percentage lung ventilation on the operated side was the primary endpoint as assessed with electrical impedance tomography (EIT). Secondary endpoints were hemidiaphragmatic motion on the operated side, pain, opioid use, hand strength and numbness, and patient satisfaction. RESULTS Before regional anaesthesia, the lung on the operated side contributed a median [IQR] of 50 [42 to 56]% of the total lung ventilation. Postoperatively, it was 40 [3 to 50]% (SSNB) vs. 3 [1 to 13]% (ISB) for an adjusted difference of 23 (95% CI, 13 to 34)%, (P |
| Databáze: | OpenAIRE |
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