Hemidiaphragmatic paralysis following ultrasound‐guided anterior vs. posterior suprascapular nerve block: a double‐blind, randomised control trial
2020/01/26 by F. Ferré, Fabrice Ferré, M. Pommier +15 · 19 citations
Medicine · #Anesthesia and Pain Management #Pediatric Pain Management Techniques #Shoulder Injury and Treatment
paper · pdf · doi:10.1111/anae.14978
Abstract
Interscalene brachial plexus block provides analgesia for shoulder surgery but is associated with hemidiaphragmatic paralysis. Before considering a combined suprascapular and axillary nerve block as an alternative to interscalene brachial plexus block, evaluation of the incidence of diaphragmatic dysfunction according to the approach to the suprascapular nerve is necessary. We randomly allocated 84 patients undergoing arthroscopic shoulder surgery to an anterior or a posterior approach to the suprascapular nerve block combined with an axillary nerve block using 10 ml ropivacaine 0.375% for each nerve. The primary outcome was the incidence of hemidiaphragmatic paralysis diagnosed by ultrasound. Secondary outcomes included: characterisation of the hemidiaphragmatic paralysis over time; numeric rating scale pain scores; oral morphine equivalent consumption; and patient satisfaction. The incidence of hemidiaphragmatic paralysis was 40% (n = 17) vs. 2% (n = 1) in the anterior and posterior groups, respectively (p < 0.001). In one third of patients with hemidiaphragmatic paralysis, it persisted beyond the eighth hour. The median (interquartile range [range]) oral morphine equivalent consumption was significantly higher in the posterior approach when compared with the anterior approach, whether in the recovery area (20 [5-31 (0-60)] mg vs. 7.5 [0-14 (0-52)] mg, respectively; p = 0.004) or during the first 24 h (82 [61-127 (12-360) mg] vs. 58 [30-86 (0-160)] mg, respectively; p = 0.01). Patient satisfaction was comparable between groups (p = 0.6). Compared with the anterior approach, diaphragmatic function is best preserved with the posterior needle approach to the suprascapular nerve block.
Citations
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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. [europepmc]
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- Comparing C3, 4, and 5 nerve root block and interscalene with intermediate cervical plexus block in diaphragmatic motion for clavicle surgery. [europepmc]
- Pathway from anterior suprascapular nerve block to the phrenic nerve: a cadaveric dye study. [europepmc]
- Statistical fragility of reporting hemidiaphragmatic paralysis after brachial plexus blocks in randomized controlled trials: a systematic review. [europepmc]
- Maximum effective volume of 0.25% ropivacaine for preventing hemidiaphragmatic paralysis in 90% of patients undergoing shoulder arthroscopy: a biased coin up-and-down sequential allocation trial for ultrasound-guided superior trunk block. [europepmc]
- Effect of liposomal bupivacaine for the suprascapular nerve combined with axillary nerve block on postoperative analgesia in patients undergoing shoulder surgery: a randomized, observer-blinded trial. [europepmc]
- Optimizing the superior trunk block for arthroscopic shoulder surgery: a randomized, double-blind comparison of low- vs. conventional-dose ropivacaine on anesthesia, analgesia, and diaphragmatic function. [europepmc]
- Pre-injection of saline on the anterior scalene muscle reduced brachial plexus nerve block-induced hemidiaphragmatic paralysis. [europepmc]
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