Preoperative interscalene brachial plexus block aids in perioperative temperature management during arthroscopic shoulder surgery

Abstract

BackgroundHypothermia is common during arthroscopic shoulder surgery under general anesthesia, and anesthetic-impaired thermoregulation is thought to be the major cause of hypothermia. This prospective, randomized, double-blind study was designed to compare perioperative temperature during arthroscopic shoulder surgery with interscalene brachial plexus block (IBPB) followed by general anesthesia vs. general anesthesia alone.MethodsPatients scheduled for arthroscopic shoulder surgery were randomly allocated to receive IBPB followed by general anesthesia (group GB, n = 20) or general anesthesia alone (group GO, n = 20), and intraoperative and postoperative body temperatures were measured.ResultsThe initial body temperatures were 36.5 ± 0.3℃ vs. 36.4 ± 0.4℃ in group GB vs. GO, respectively (P = 0.215). The body temperature at 120 minutes after induction of anesthesia was significantly higher in group GB than in group GO (35.8 ± 0.3℃ vs. 34.9 ± 0.3℃; P < 0.001). The body temperatures at 60 minutes after admission to the post-anesthesia care unit were 35.8 ± 0.3℃ vs. 35.2 ± 0.2℃ in group GB vs. GO, respectively (P < 0.001). The concentrations of desflurane at 0, 15, and 120 minutes after induction of anesthesia were 6.0 vs. 6.0% (P = 0.330), 5.0 ± 0.8% vs. 5.8 ± 0.4% (P = 0.001), and 3.4 ± 0.4% vs. 7.1 ± 0.9% (P < 0.001) in group GB vs. GO, respectively.ConclusionsThe present study demonstrated that preoperative IBPB could reduce both the intraoperative concentration of desflurane and the reduction in body temperature during and after arthroscopic shoulder surgery.

Effect of short-term prewarming on body temperature in arthroscopic shoulder surgery

“…The temperature of our patients could have been higher than that in the study of Lim et al [20] due to prewarming and intraoperative warming in our study.…”

“…Lim et al [20] have shown that ISBPB procedure can reduce the risk of perioperative hypothermia caused by anestheticimpaired thermoregulation by decreasing the requirement of general anesthetics. The temperature of our patients could have been higher than that in the study of Lim et al [20] due to prewarming and intraoperative warming in our study.…”

The effect of interscalene brachial plexus block with propofol sedation on preventing perioperative hypothermia during arthroscopic shoulder surgery

“…Lim et al [ 8 ] reported that performing ISBPB in the preoperative period with general anesthesia reduced the amount of inhalation anesthetic required and consequently decreased the degree of perioperative hypothermia. A combination of general anesthesia and ISBPB may be beneficial for perioperative temperature management by reducing the impairment of thermoregulation by anesthetic agents.…”

“…Various methods have been reported to prevent hypothermia during an arthroscopic shoulder surgery [ 1 , 2 , 8 – 13 ], and only few studies assessing interscalene brachial plexus block (ISBPB), which is widely used for postoperative pain control in shoulder surgery, have been reported [ 8 – 10 ]. A previous study reported that preoperative ISBPB can be useful in preventing hypothermia by reducing the amount of volatile anesthetics in patients undergoing arthroscopic shoulder surgery under general anesthesia [ 8 ]. However, other studies have reported that hypothermia occurs more frequently in elderly patients or when active warming is not performed despite using preoperative ISBPB with general anesthesia [ 9 , 10 ].…”

How to get away from the cold: body temperature during surgery

“…The suppression of thermoregulatory defense mechanisms during general anesthesia is dose-dependent and mostly results in perioperative hypothermia [ 6 ]. In this issue of Korean Journal of Anesthesiology ( KJA ), Lim et al [ 7 ] report that a combined interscalene block and general anesthesia reduced the concentration of desflurane and prevented intraoperative hypothermia during arthroscopic shoulder surgery. The core temperature of patients who receive only an interscalene block should be monitored to evaluate the effect of the block alone.…”