A combination of infraclavicular and suprascapular nerve blocks for total shoulder arthroplasty: A case series

Musso, Dario; Klaastad, Øivind; Ytrebø, Lars Marius

doi:10.1111/aas.13787

Cited by 7 publications

(7 citation statements)

References 27 publications

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“…The incidence of HDP following different approaches of ICB is relatively low, which is 3% during the classical approach of ICB with 20 mL LA, [6] 15% after retroclavicular block with 25 mL LA, [7] and 2.5% to 5% after CCB (a new infraclavicular approach targeting the three cords that could provide sufficient analgesia for shoulder surgery by retrograde diffusion of LA to the supraclavicular nerve) with 20 to 30 mL LA, respectively [3,8] . The combination of ICB and anterior suprascapular block for shoulder surgery yielded an HDP rate of 5% [9] . The superior trunk block, a new block developed to minimize the involvement of the phrenic nerve by injecting LA next to the upper trunk of the brachial plexus (prior to the separation of the suprascapular nerve), has an HDP rate of 4.8% [10] .…”

Section: Discussionmentioning

confidence: 99%

“…[3,8] The combination of ICB and anterior suprascapular block for shoulder surgery yielded an HDP rate of 5%. [9] The superior trunk block, a new block developed to minimize the involvement of the phrenic nerve by injecting LA next to the upper trunk of the brachial plexus (prior to the separation of the suprascapular nerve), has an HDP rate of 4.8%. [10] Axillary tunnel catheter indwelling to avoid phrenic nerve block still resulted in a 1.5% incidence of HDP.…”

Section: Retrospective Analysismentioning

confidence: 99%

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Dyspnea induced by hemidiaphragmatic paralysis after ultrasound-guided supraclavicular brachial plexus block in a morbidly obese patient

et al. 2022

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Rationale: Hemidiaphragmatic paralysis (HDP) is a frequent complication of the brachial plexus block, caused by unintentional blockade of ipsilateral phrenic nerve. HDP did not rise enough alarm and attention to most anesthesiologists, because most patients with no coexisting comorbid diseases are asymptomatic and able to tolerate it. However, it may cause severe respiratory complication for patients with preexisting compromised cardiorespiratory function. Patient concerns: A 67-year-old woman with morbidly obesity was planned to receive opening reduction and internal fixation of right humeral shaft fracture under regional anesthesia considering less respiratory and cardiovascular system interference compared with general anesthesia. Diagnoses: After ultrasound guided supraclavicular brachial plexus block, the patient developed severe hypoxia and hypercapnia.Unintentional block of phrenic nerve and diaphragm paralysis was diagnosed by diaphragm ultrasound, which was considered as the main reason of severe hypoxia. Interventions: It led to a conversion from regional anesthesia to general anesthesia with endotracheal intubation for patient's safety and smooth operation. Outcomes: The unintentional phrenic nerve block leads to a prolonged ventilation time, length of stay in intensive care unit and length of stay in hospital. Lessons: This case report highlights the risk of diaphragm paralysis in morbidly obese patients. Though new diaphragm sparing brachial plexus block (BPB) methods were developed intended to reduce the risk of HDP, no approaches could absolutely spare phrenic nerve involvement. Therefore, clinicians should always consider the risk of HDP associated with BPBs. For each individual, a detailed preoperative evaluation and sufficient preparation are paramount to avoid serious complications.

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Section: Discussionmentioning

confidence: 99%

Section: Retrospective Analysismentioning

confidence: 99%

Dyspnea induced by hemidiaphragmatic paralysis after ultrasound-guided supraclavicular brachial plexus block in a morbidly obese patient

et al. 2022

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“…The sample size is calculated at 90% power and based on variation in the NRS for pain for the study population using the formula [ 8 ], \begin{document}n = \kappa \frac{\left (Z _{\alpha }+ Z_{\beta } \right )^{2} \left ( \sigma ^{2} \right )}{d^{2}}\end{document} , where \begin{document}\sigma\end{document} = 3.0, the IQR of the maximum score on the NRS for pain; d = 30% of median score on the NRS for pain (=6.5), the difference considered to be clinically significant; design effect \begin{document}\kappa\end{document} = 1; type I error α = 5% corresponding to a 95% confidence level, type II error β = 10% for detecting results with 90% power of study. So, the required sample size is n = 31 for each group.…”

Section: Methodsmentioning

confidence: 99%

“…The sample size is calculated at 90% power and based on variation in the NRS for pain for the study population using the formula [8],…”

Section: Sample Size Calculationmentioning

confidence: 99%

Efficacy of Infraclavicular Brachial Plexus Block Alone Versus Combination With Suprascapular Nerve Block in Patients Undergoing Shoulder Surgeries: A Single-Blind, Randomized Trial

Saxena,

Singh,

Chaurasia

et al. 2024

Cureus

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Background and aim The regional anesthesia technique is commonly used for upper extremity surgery as an alternative to general anesthesia. The study aimed to compare the efficacy of infraclavicular brachial plexus block (BPB) and a combination of infraclavicular brachial plexus block with suprascapular nerve block for postoperative analgesia in patients undergoing shoulder surgeries. Method A total of 62 patients of both sexes with the American Society of Anaesthesiologists (ASA) physical status I/II/III, aged between 18 and 65 years, and undergoing shoulder surgery, were included in this prospective, single-blinded, randomized controlled trial. Patients were equally allocated into two groups: 31 in group A and 31 in group B. After pre-anesthetic evaluation, the purpose and protocol of the study were explained to patients, and informed consent was obtained. Thirty-one patients in group A were given infraclavicular brachial plexus block using 30 ml 0.375% bupivacaine while 31 patients in group B were given a combination of infraclavicular brachial plexus block using 30 ml 0.375% bupivacaine and suprascapular nerve block using 5 ml 0.375% bupivacaine. Blocks were given using ultrasound guidance and a peripheral nerve stimulator; the suprascapular block was given in the sitting position while the infraclavicular block was provided in the supine position. General anesthesia was administered in the operation theatre in the supine position after the administration of blocks. The pain was assessed using the visual analog scale (VAS) and the satisfaction score was assessed by the numeric rating scale (NRS). The Mann-Whitney U test was applied for comparison of pain between the two groups. The chi-square test was utilized for comparing the categorical variables. Result The postoperative pain was significantly lower (p<0.001) in group B as compared to group A at all the periods of observation, i.e., 0h (2.77±0.72 vs. 5.42±0.77), 6h (3.89±0.70 vs. 5.94±0.73), 12h (5.66±0.93 vs. 6.58±0.88), and 24h (6.16±0.80 vs. 6.74±0.90). These findings illustrate that group B patients who received a combination of infraclavicular brachial plexus block and suprascapular nerve block for shoulder surgeries had better pain relief than group A patients who received only the infraclavicular approach. The mean NRS score of patient satisfaction in group B (7.26±0.58) was significantly higher (p<0.001) in comparison to group A (6.16±0.64). Diaphragmatic palsy was observed in only one case in group A and none in group B. No other complication was observed in any of the patients during the study period. Conclusion The combination of infraclavicular brachial plexus block and suprascapular nerve block displays a positive postoperative analgesic profile with less usage of rescue analgesic doses and better patient satisfaction after shoulder surgery.

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“…A single patient (5%) experienced hemi-diaphragmatic paralysis. Musso et al [48] reported no interscalene block technique resulted in a risk of hemi-diaphragmatic paralysis less than 27%.…”

Section: Infraclavicular Brachial Plexus Block Combined With Suprasca...mentioning

confidence: 99%

Postoperative pain control for shoulder arthroplasty

Walker,

Kamineni

2024

Clin Shoulder Elb

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Since its inception in 1893, shoulder arthroplasty has become an increasingly common surgical procedure. Between 1998 and 2008, shoulder arthroplasty procedures increased by nearly 28,000 cases per year in the United States alone and is the fastest growing joint replacement surgery among all joint. Despite its advantages, shoulder arthroplasty is often accompanied by significant postoperative pain. Pain control continues to be a major concern in patient management, as it impacts operative costs, postoperative mobility, length of hospital stay, patient satisfaction, and overall surgical outcomes. This review aims to provide an overview of drugs such as opioids and regional anesthetics, as well as methods such as local wound infiltration, nerve block, brachial plexus infiltration, cryotherapy and multimodal approaches employed in postoperative shoulder arthroplasty pain control.

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A combination of infraclavicular and suprascapular nerve blocks for total shoulder arthroplasty: A case series

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 7 publications

References 27 publications

Dyspnea induced by hemidiaphragmatic paralysis after ultrasound-guided supraclavicular brachial plexus block in a morbidly obese patient

Dyspnea induced by hemidiaphragmatic paralysis after ultrasound-guided supraclavicular brachial plexus block in a morbidly obese patient

Efficacy of Infraclavicular Brachial Plexus Block Alone Versus Combination With Suprascapular Nerve Block in Patients Undergoing Shoulder Surgeries: A Single-Blind, Randomized Trial

Postoperative pain control for shoulder arthroplasty

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