Effect of brachial plexus block on the incidence of arterial hypotension and bradycardia events during shoulder arthroscopy in adolescents

Abstract

Background. The role and significance of the technical aspects of interscalene brachial plexus block in the occurrence of sudden arterial hypotension and bradycardia events during shoulder arthroscopy in a semi-sitting position are ambiguous.
 Aim. The study aimed to assess the effect of interscalene brachial plexus block on the incidence of hypotension-bradycardia events during shoulder arthroscopic surgery in adolescents in a semi-sitting position.
 Materials and methods. This retrospective analysis of anesthesia protocols included 288 patients who underwent arthroscopic shoulder surgery in a semi-sitting position under the interscalene brachial plexus block. Regional blockades were performed with neurostimulation in Group 1 (n = 23), neurostimulation and ultrasound navigation without repositioning the needle in Group 2 (n = 70), and neurostimulation and ultrasound navigation with multiple precision repositioning the needle in Group 3 (n = 195).
 Results. Hypotension-bradycardia events were detected in 26 patients out of 288 (9%). There was a statistically significant difference in the frequency of hypotension-bradycardia in all groups: 10 (43.48%) in Group 1, 15 (21.43%) in Group 2, and 1 (0.51%) in Group 3 (p = 0.000). A direct correlation between hypotension-bradycardia episodes and local anesthetic volume (r = 0.405; p 0.05), and Horners syndrome (r = 0.684, p 0.05) was found.
 Conclusions. Interscalene brachial plexus block with a target delivery of low volume of local anesthetic and dual navigation reduces the risk of hypotension-bradycardia. Horners syndrome can be considered an early predictor of hypotension-bradycardia events.

[Retracted] Clinical Application of Ultrasound Microscopy‐Guided Pediatric Brachial Plexus Nerve Block Anesthesia

“…Kantharaja et al investigated the adhesive adhesion of ductile TiN and brittle CrN thin-layers by analyzing acoustic emission signals from scratch tests under predetermined loads [ 12 ]. Trukhin et al used acoustic emission to detect damage to polymer thin-layers and found that the acoustic signal increased when corrosion occurred under the thin layer [ 13 ]. Rd A. et al related the size and propagation of defects in thin layers of plasma-sprayed zirconia at high temperatures to acoustic emission signal parameters [ 14 ].…”

Unprecedented emergencies during radiofrequency ablation procedure: a case series

“…Therefore, the high incidence and potential for catastrophic complications should be considered when shoulder intervention is performed in aged patients in the sitting position for long duration. [8][9][10] Neuropathy after RFA has been published as case reports following Third Occipital Nerve ablation with RFA. Mechanical injury to the nerve can be secondary to direct needle trauma, compression of the nerve, or stretching of the nerve during positioning.…”