Comparison of two different volumes of ropivacaine used in nerve stimulator guided inter-scalene block for arthroscopic shoulder surgery – A randomized controlled trial

Sahu, Ghanshyam Kumar; Meena, Dharam Singh; Saini, Suman; Aravindan, Ajisha; Datta, Priyankar Kumar

doi:10.4103/aer.aer_122_18

Cited by 1 publication

(2 citation statements)

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“…However, two studies reported signifcant reductions in HDP incidence when 5 mL was injected under US guidance compared to a control ISB using 10 mL [74] and 20 mL of ropivacaine [73]. Trials by Sinha et al [75] and Meena et al [80] demonstrated similar HDP incidences for a 10 mL and 20 mL ISB performed under US and NS guidance, respectively. All of these groups reported statistically similar analgesia in the high-and low-volume study groups in the postoperative period.…”

Section: Interscalene Block Resultsmentioning

confidence: 98%

“…Whilst such low-volume injections are not currently standard practice due to concerns over inadequate analgesic efficacy [ 35 ], these studies demonstrated that they provide sufficient analgesia. The introduction of US-guided blocks, which have since become the standard of care [ 80 ], has allowed accurate deposition of LA directly adjacent to the target nerves, thus reducing the volume required. Recent studies have shown that, under US guidance, effective analgesia can be achieved with ISB using as little as 0.9 mL [ 88 ].…”

Section: Discussionmentioning

confidence: 99%

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Impact of Peripheral Nerve Block Technique on Incidence of Phrenic Nerve Palsy in Shoulder Surgery

Campbell,

Johnson,

O’Connor

2023

Anesthesiology Research and Practice

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Peripheral nerve blocks are an increasingly common method of providing postoperative analgesia for shoulder surgeries. However, the standard technique, the interscalene block (ISB), inevitably causes hemidiaphragmatic paresis (HDP), secondary to phrenic nerve palsy. This can cause morbidity in patients with preexisting respiratory compromise, prompting investigation into alternative “phrenic-sparing” nerve blocks. The aim of this review was to give an overview of these blocks and critically evaluate the current literature to determine if any are suitable replacements for ISB. The incidence of HDP and analgesic efficacy were considered. We queried four electronic databases and one register. Twenty-eight original articles were selected for review. The use of ultrasound guidance, lower volumes of local anaesthetic (LA), and injection 4 mm outside the brachial plexus fascia reduced HDP incidence for the ISB; however, no single modification did so sufficiently. While the anterior suprascapular nerve block (SSNB) showed comparable analgesic effects to the ISB, HDP prevalence was also high. The posterior SSNB produced consistently low HDP incidences but also inferior analgesia to ISB, except when combined with an infraclavicular brachial plexus block. The superior trunk block (STB) provided equivalent analgesia to the ISB while reducing HDP incidence, but not significantly. Lower LA volumes consistently led to lower HDP incidence across all blocks, likely due to a reduced ability to spread to the phrenic nerve. Further investigation into the minimum effective volumes of the extrafascial ISB, anterior SSNB, STB, and combined posterior SSNB with infraclavicular block is warranted to determine if any of these blocks can successfully balance HDP prevention with analgesic efficacy.

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