Ultrasound standard of peripheral nerve block for shoulder arthroscopy: a single-penetration double-injection approach targeting the superior trunk and supraclavicular nerve in the lateral decubitus position

Lin, Jui-An; Chuang, Tai-Yuan; Yao, Han-Yun; Yang, Sheng-Feng; Tai, Yu‐Ting

doi:10.1093/bja/aev384

Cited by 18 publications

(15 citation statements)

References 16 publications

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“…The ultrasound-guided superior trunk block has only been described in two case reports, 9,21 and this study is the first randomized controlled trial to evaluate the technique in comparison with the conventional ultrasound-guided interscalene brachial plexus block. In this noninferiority clinical trial, we demonstrated that the superior trunk block provided postoperative shoulder analgesia equivalent to that of the interscalene brachial plexus block, as demonstrated by similar pain scores and area under the pain curve up to 24 h postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…5 However, the C5 root and C6 nerve rootlets inevitably unite to form the superior trunk regardless of the variations in root anatomy proximal to this point, and thus anatomical variation is inconsequential to the superior trunk block. 9,21 In addition, unlike the C5 and C6 roots, the superior trunk is surrounded by a clearly visible and well defined connective sheath. This not only facilitates target visualization and identification but also enhances resilience to needle-nerve contact.…”

Section: Discussionmentioning

confidence: 99%

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Superior Trunk Block Provides Noninferior Analgesia Compared with Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery

et al. 2019

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Background: Interscalene brachial plexus block of the C5-C6 roots provides highly effective postoperative analgesia after shoulder surgery but usually results in hemidiaphragmatic paresis. Injection around the superior trunk of the brachial plexus is an alternative technique that may reduce this risk. The authors hypothesized that the superior trunk block would provide noninferior postoperative analgesia compared with the interscalene block and reduce hemidiaphragmatic paresis. Methods: Eighty patients undergoing arthroscopic shoulder surgery were randomized to receive a preoperative injection of 15 ml of 0.5% ropivacaine and 5 μg • ml −1 epinephrine around either (1) the C5-C6 nerve roots (interscalene block group) or (2) the superior trunk (superior trunk block group). The primary outcome was pain intensity 24 h after surgery measured on an 11-point numerical rating score; the prespecified noninferiority limit was 1. Diaphragmatic function was assessed using both ultrasonographic measurement of excursion and incentive spirometry by a blinded investigator before and 30 min after block completion. Results: Seventy-eight patients completed the study. The pain score 24 h postoperatively (means ± SDs) was 1.4 ± 1.0 versus 1.2 ± 1.0 in the superior trunk block (n = 38) and interscalene block (n = 40) groups, respectively. The mean difference in pain scores was 0.1 (95% CI, −0.3 to 0.6), and the upper limit of the 95% CI was lower than the prespecified noninferiority limit. Analgesic requirements and all other pain measurements were similar between groups. Hemidiaphragmatic paresis was observed in 97.5% of the interscalene block group versus 76.3% of the superior trunk block group (P = 0.006); paresis was complete in 72.5% versus 5.3% of the patients, respectively. The decrease in spirometry values from baseline was significantly greater in the interscalene block group. conclusions: The superior trunk block provided noninferior analgesia compared with interscalene brachial plexus block for up to 24 h after arthroscopic shoulder surgery and resulted in significantly less hemidiaphragmatic paresis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Superior Trunk Block Provides Noninferior Analgesia Compared with Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery

et al. 2019

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“…This is especially important for anterior and lateral QL blocks, because nerves are located anterior to the QL where the needle tip will be placed (Figure 1). Another reason for adding the half-the-air pressure monitor is to reduce the risk of local anesthetic systemic toxicity (LAST) and at the same time save the local anesthetic when the block site is deep with rich vascularity [16] and needs test injection to confirm the correct spread in the interfascial plane [17], such as the deep anterior QL block involving the thoracolumbar fascia through which vessels exit from the paravertebral space [14]. …”

Section: Techniques Of Ql Blockmentioning

confidence: 99%

Ultrasound-Guided Quadratus Lumborum Block: An Updated Review of Anatomy and Techniques

Ueshima

Okumura

Lin

2017

BioMed Research International

282

167

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Purpose of Review. Since the original publication on the quadratus lumborum (QL) block, the technique has evolved significantly during the last decade. This review highlights recent advances in various approaches for administering the QL block and proposes directions for future research. Recent Findings. The QL block findings continue to become clearer. We now understand that the QL block has several approach methods (anterior, lateral, posterior, and intramuscular) and the spread of local anesthetic varies with each approach. In particular, dye injected using the anterior QL block approach spread to the L1, L2, and L3 nerve roots and within psoas major and QL muscles. Summary. The QL block is an effective analgesic tool for abdominal surgery. However, the best approach is yet to be determined. Therefore, the anesthetic spread of the several QL blocks must be made clear.

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“…Although not commonly performed, the superior trunk block could provide a safer target for catheter placement because the locations of the needle and catheter tip should be easily visible when using ultrasound. A recent letter by Lin et al described a single puncture approach to block both the supraclavicular nerves and the superior trunk of the brachial plexus , however much more work is required to determine the safety and efficacy of these blocks before they can be recommended.…”

Section: Alternative Blocksmentioning

confidence: 99%

Interscalene catheters ‐ should we give them the cold shoulder?

2016

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Ultrasound standard of peripheral nerve block for shoulder arthroscopy: a single-penetration double-injection approach targeting the superior trunk and supraclavicular nerve in the lateral decubitus position

Cited by 18 publications

References 16 publications

Superior Trunk Block Provides Noninferior Analgesia Compared with Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery

Superior Trunk Block Provides Noninferior Analgesia Compared with Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery

Ultrasound-Guided Quadratus Lumborum Block: An Updated Review of Anatomy and Techniques

Interscalene catheters ‐ should we give them the cold shoulder?

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