Comparison of Ultrasound and Peripheral Nerve Stimulator Guidance for Interscalene Brachial Plexus Block in Shoulder Arthroscopy Patients

Öz

The aim of this study was to investigate the differences in terms of operation success, efficacy and complications among patients who underwent interscalene brachial plexus block with the guidance of ultrasound and peripheral nerve stimulator and only peripheral nerve stimulator. Fifty-two patients who would underwent unilateral shoulder arthroscopy were randomized and included in the study. Interscalene brachial plexus block was performed under the guidance of ultrasound and peripheral nerve stimulator in Group I (n=26) and only peripheral nerve stimulator in Group II (n=26). Block success rates, block durations, opioid consumption at intraoperative period, and 10 and 24 hours postoperatively, sleep quality and complications were recorded. No statistically significant difference was observed between the groups in terms of block success rates, intraoperative, and postoperative 10th and 24th hour pain levels and postoperative sleep quality. Sensorial block duration was significantly higher in Group I (823±151 min) than Group II (714±161 min) (p<0.05). There was no significant difference between the groups in terms of phrenic and recurrent laryngeal nerve paralysis, and the rate of Horner syndrome was significantly higher in Group I (%54) than Group II (%27), (p<0.05). In shoulder arthroscopy operations, ultrasound use with peripheral nerve stimulator in interscalene brachial plexus block prolongs the duration of block action and contributes to postoperative analgesia and improves patient comfort.

Anahtar Kelimeler

• Arthroscopy,Brachial Plexus Block,Peripheral Nerve Stimulator,Ultrasound

Omuz Artroskopisinde İnterskalen Brakiyal Pleksus Bloğu Uygulanan Hastalarda Periferik Sinir Stimülatörü ve Ultrason Kullanımının Karşılaştırılması

Öz

Çalışmanın amacı, interskalen brakiyal pleksus bloğunda yalnız periferik sinir stimülatörü kullanımı ile periferik sinir stimülatörü ve ultrasonografi eş zamanlı kullanımının işlem başarısı, etkinlik ve komplikasyonlar açısından farklarının araştırılmasıdır.Tek taraflı omuz artroskopisi planlanan, parsiyel rotator kaf yırtığı olan 52 hasta, randomize edilerek çalışmaya dahil edildi. Grup I’de (n=26) ultrasonografi rehberliğinde PSS, Grup II’de (n=26) yalnız periferik sinir stimülatörü eşliğinde interskalen brakiyal pleksus bloğu uygulandı. Blok başarı oranları, duyusal blok etki süreleri, intraoperatif, postoperatif 10. ve 24. saat opioid tüketimleri, uyku kaliteleri ve komplikasyonlar kaydedildi. Gruplar arasında blok başarı oranları, intraoperatif, postoperatif 10. ve 24. saat opioid tüketimleri, postoperatif uyku kaliteleri açısından istatistiksel olarak anlamlı fark gözlenmedi. Duyusal blok süresi Grup I’de (823±151 dk) Grup II’ye (714±161 dk) göre anlamlı seviyede yüksek bulundu (p<0.05). Komplikasyon olarak frenik ve rekürren laringeal sinir paralizisi açısından gruplar arası anlamlı fark gözlenmezken,  Horner sendromu gözlenme oranı, Grup I’de (%54), Grup II’ye (%27) göre anlamlı yüksek bulundu (p<0.05). Omuz artroskopisi ameliyatlarında, interskalen brakiyal pleksus bloğunda periferik sinir stimülatörü ile birlikte ultrasonografi kullanımı blok etki süresini uzatarak, postoperatif analjeziye katkı sağlar ve hasta konforunu artırır.

Anahtar Kelimeler

• Artroskopi,Brakiyal Pleksus Bloğu,Periferik Sinir Stimülatörü,Ultrason

Kaynakça

1. 1. Wilson AT, Nicholson E, Burton L, Wild C. Analgesia for day-case shoulder surgery. Br J Anaesth. 2004;92(3):414-5.
2. 2. Morey TE, Wright TW, Chidgey LK, Enneking FK. Continuous interscalene brachial plexus block for postoperative pain control at home: a randomized, double-blinded, placebo-controlled study. Anesth Analg. 2003;96(4):1089–95.
3. 3. Shin S-W, Byeon G-J, Yoon J-U, et al. Effective analgesia with ultrasound-guided interscalene brachial plexus block for postoperative pain control after arthroscopic rotator cuff repair. J Anesth. 2014;28(1):64-9.
4. 4. Chan VWS. Applying ultrasound imaging to interscalene brachial plexus block. Reg Anesth Pain Med. 2003;28(4):340-3.
5. 5. Kapral S, Greher M, Huber G, et al. Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth Pain Med. 2008;33(3):253-8.
6. 6. Perlas A, Chan VWS, Simons M. Brachial plexus examination and localization using ultrasound and electrical stimulation: a volunteer study. Anesthesiology. 2003;99(2):429-35.
7. 7. Winnie AP. Interscalene brachial plexus block. Anesth Analg. 1970;49(3):455-66.
8. 8. Spence BC, Beach ML, Gallagher JD, Sites BD. Ultrasound-guided interscalene blocks: understanding where to inject the local anaesthetic. Anaesthesia. 2011;66(6):509-14.

9. 9. Casati A, Danelli G, Baciarello M, et al. A prospective, randomized comparison between ultrasound and nerve stimulation guidance for multiple injection axillary brachial plexus block. Anesthesiology. 2007;106(5):992-6.
10. 10. McNaught A, Shastri U, Carmichael N, et al. Ultrasound reduces the minimum effective local anaesthetic volume compared with peripheral nerve stimulation for interscalene block. Br J Anaesth. 2011;106(1):124-30.
11. 11. Riazi S, Carmichael N, Awad I, Holtby RM, McCartney CJL. Effect of local anaesthetic volume (20 vs 5 ml) on the efficacy and respiratory consequences of ultrasound-guided interscalene brachial plexus block. Br J Anaesth. 2008;101(4):549-56.
12. 12. Kolny M, Stasiowski MJ, Zuber M, et al. Randomized, comparative study of the effectiveness of three different techniques of interscalene brachial plexus block using 0.5% ropivacaine for shoulder arthroscopy. Anaesthesiol Intensive Ther. 2017;49(1):47-52.
13. 13. Borgeat A, Schäppi B, Biasca N, Gerber C. Patient-controlled analgesia after major shoulder surgery: patient-controlled interscalene analgesia versus patient-controlled analgesia. Anesthesiology. 1997;87(6):1343-7.
14. 14. Neal JM, Brull R, Horn J-L, et al. The second american society of regional anesthesia and pain medicine evidence-based medicine assessment of ultrasound-guided regional anesthesia. Reg Anesth Pain Med. 2016;41(2):181-94.
15. 15. Marhofer P, Harrop-Griffiths W, Kettner SC, Kirchmair L. Fifteen years of ultrasound guidance in regional anaesthesia: part 1. Br J Anaesth. 2010;104(5):538-46.
16. 16. Ghodki PS, Singh ND. Incidence of hemidiaphragmatic paresis after peripheral nerve stimulator versus ultrasound guided interscalene brachial plexus block. J Anaesthesiol Clin Pharmacol. 2016;32(2):177-81.
17. 17. Kot Baixauli P, Rodriguez Gimillo P, Baldo Gosalvez J, de Andrés Ibáñez J. Usefulness of diaphragmatic ultrasound in the early diagnosis of phrenic nerve palsy after shoulder surgery in the prevention of post-operative respiratory complications. Rev Esp Anestesiol Reanim. 2018;65(10):593-6.
18. 18. Verhey PT, Gosselin MV, Primack SL, Kraemer AC. Differentiating diaphragmatic paralysis and eventration. Acad Radiol. 2007;14(4):420-5.
19. 19. Urmey WF, McDonald M. Hemidiaphragmatic paresis during interscalene brachial plexus block: effects on pulmonary function and chest wall mechanics. Anesth Analg. 1992;74(3):352-7.