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Randomized, controlled trial comparing respiratory and analgesic effects of interscalene, anterior suprascapular, and posterior suprascapular nerve blocks for arthroscopic shoulder surgery

대한마취과학회지 2020년 73권 5호 p.408 ~ 416
Lim Yean Chin, Koo Zhao Kun, Ho Vivian W., Chang See Seong, Manohara Shivani, Tong Qian Jun,
소속 상세정보
 ( Lim Yean Chin ) - Changi General Hospital Department of Anaesthesia and Surgical Intensive Care
 ( Koo Zhao Kun ) - Changi General Hospital Department of Anaesthesia and Surgical Intensive Care
 ( Ho Vivian W. ) - Changi General Hospital Department of Anaesthesia and Surgical Intensive Care
 ( Chang See Seong ) - Changi General Hospital Department of Anaesthesia and Surgical Intensive Care
 ( Manohara Shivani ) - Changi General Hospital Department of Anaesthesia and Surgical Intensive Care
 ( Tong Qian Jun ) - Changi General Hospital Department of Anaesthesia and Surgical Intensive Care

Abstract


Background: Interscalene brachial plexus block (ISB) provides excellent analgesia for arthroscopic shoulder surgeries but is associated with adverse effects including hemidiaphragmatic paresis. We aimed to compare the respiratory effects, forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) between suprascapular nerve block (SSB) and ISB.

Methods: Sixty patients were recruited and randomized into ISB, anterior SSB, and posterior SSB groups. FVC, FEV1, and diaphragmatic excursion were evaluated at baseline and 30 minutes after intervention. Blocks were performed under ultrasound guidance with 15 ml of 0.5% ropivacaine. Pain scores were assessed at 1, 6, 12, and 24 hours postoperatively.

Results: The ISB group showed a reduced FVC of 31.2% ± 17.5% (mean ± SD), while the anterior and posterior SSB groups had less reduction of 3.6% ± 18.6% and 6.8% ± 6.5%, respectively (P < 0.001). The ISB group showed more reduction in diaphragmatic excursion than the anterior and posterior SSB groups (median [IQR]): ?85.7% (?95.3% to ?63.3%) vs. ?1.8% (?13.1% to 2.3%) and ?1.2% (?8.8% to 16.8%), respectively (P < 0.001). The median pain scores (IQR) in the ISB and anterior SSB groups were lower than those in the posterior SSB group at 6 hours on movement: 0 (0?2), 1.8 (0?4.5) vs. 5 (2.5?8), respectively (P = 0.002). There was no significant difference in oxycodone consumption postoperatively.

Conclusions: Anterior SSB preserves lung function and has a comparable analgesic effect as ISB. Thus, it is recommended for arthroscopic shoulder surgeries, especially in patients who have reduced lung function.

키워드

Analgesia; Interscalene block; Regional anesthesia; Respiratory function; Shoulder arthroscopy; Suprascapular block

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