Reply to Tognù<i>et al</i>: regional anesthesia for proximal humerus surgery during COVID-19 pandemic

Mistry, Tuhin; Kuppusamy, Elayavendhan

doi:10.1136/rapm-2020-101729

Cited by 7 publications

(2 citation statements)

References 4 publications

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“…Therefore, the combination mode of different approaches should be improved for a more comprehensive brachial plexus block. The hybrid technique of interscalene and supraclavicular approach, interscalene and C8 block, or selective trunks block was recently proposed to completely block the three brachial trunks in PHF surgery (11,(20)(21)(22). However, none of the modes was supported by neither the large cohort of patients nor the randomized controlled trial.…”

Section: Discussionmentioning

confidence: 99%

“…However, the hybrid technique of the superficial cervical plexus block and the interscalene block, which is an effective mode of RA in clavicle and shoulder surgery (7)(8)(9), cannot always provide sufficient surgical anesthesia for the patients undergoing PHF surgery. In previous studies, the branches stem from the upper thoracic nerves (T1-T2, even T3), nearly impossible to be covered by a brachial plexus block, were considered to contribute to the innervation of the upper arm as well (10,11). Zhao (12) also recommended the T2 thoracic paravertebral block (TPVB) as a supplement for RA in PHF surgery since the thoracic paravertebral space (TPVS) houses the ventral rami of nerve roots and allows local anesthetic to spread to T1 and T3.…”

Section: Introductionmentioning

confidence: 99%

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Is It Useful and Necessary to Add a T2 Paravertebral Block to the Regional Anesthesia During Proximal Humeral Fracture Surgery in Elderly Patients? A Prospective and Randomized Controlled Trial

et al. 2022

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ObjectiveThis study was designed to investigate whether it is useful and necessary to add a T2 level thoracic paravertebral block (TPVB) based on brachial-cervical plexus block to avoid incomplete anesthesia in elderly patients undergoing deltopectoral approach proximal humeral fracture (PHF) surgery.Materials and MethodsThis study involved 80 patients scheduled for PHF surgery who were randomized to receive either IC block (combined interscalene brachial plexus with superficial cervical plexus block) or ICTP block (T2 TPVB supplemented with IC block). The primary outcome was the success rate of regional anesthesia. The patient who experienced incomplete block was administered with intravenous remifentanil for rescue, or conversion to general anesthesia (GA) if remifentanil was still ineffective. Secondary outcomes included requirements of rescue anesthesia, sensory block of the surgical region, the incidence of adverse reactions, and block procedure-related complications.ResultsThe success rate of regional anesthesia in the ICTP group was higher compared with the IC group (77.5 vs. 52.5%, p = 0.019). Intravenous remifentanil was required in 32.5% of patients in the IC group and 17.5% in the ICTP group, respectively. Conversion to GA was performed in 15% of patients in the IC group and 5% in the ICTP group. Sensory block at the medial proximal upper arm was achieved in 85% of patients in the ICTP group, whereas 10% in the IC group (p < 0.001). There was no difference between the groups with respect to the incidence of intraoperative adverse reactions. No block-related complications occurred in either group.ConclusionAdding a T2 TPVB is helpful to decrease, but not absolutely avoid the occurrence of incomplete regional anesthesia during PHF surgery in elderly patients. However, considering the potential risks, it is not an ideal option while a minor dose of remifentanil can provide a satisfactory rescue effect.Clinical Trial RegistrationClinicalTrials.gov, identifier: NCT03919422.

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Section: Discussionmentioning

confidence: 99%