Bispectral index-guided general anaesthesia in combination with interscalene block reduces desflurane consumption in arthroscopic shoulder surgery: a clinical comparison of bupivacaine versus levobupivacaine

Abstract

BackgroundThe goal of this study was to compare the influence of an interscalene brachial plexus block (ISB) performed with either bupivacaine or levobupivacaine in conjunction with general anaesthesia (GA) on desflurane consumption, which was titrated to maintain the recovery profiles and postoperative analgesia while also keeping the bispectral index score (BIS) between 40 and 60 in patients undergoing arthroscopic shoulder surgery.MethodsSixty patients undergoing arthroscopic shoulder surgery were prospectively randomized to receive GA with desflurane alone (group C) or in combination with a preoperative ISB by either bupivacaine 0.25 % (group B) 40 ml or levobupivacaine 0.25 % (group L) 40 ml. BIS scores or respiratory and hemodynamic parameters during the operation, recovery characteristics, consumed doses of desflurane and pain intensities were evaluated.ResultsThe eye opening time was 4.0 ± 2.5 minutes for group B, 4.6 ± 2.4 minutes for group L, and 6.2 ± 2.1 minutes for group C (p < 0.05). Group B and group L saved 36 % and 25 % desflurane per unit time respectively when compared with group C (p < 0.001and p < 0.05) while the mean pain scores and analgesic requirements the first day after surgery were higher in group C (p < 0.05).ConclusionsBecause of lower desflurane consumption, a superior recovery profile, and a high degree of patient acceptance, general anaesthesia in combination with interscalene block may be preferred in arthroscopic shoulder surgery.Trial registrationThe trial registration number is ACTRN12613000381785

Intraoperative Dexmedetomidine Promotes Postoperative Analgesia and Recovery in Patients after Abdominal Colectomy

“…Using this continuous infusion, we did not see significant difference in HR and MBP between the two groups, which indicated a stable anesthesia statement. BIS value has been widely accepted and well used as an index of sedation measurement in different kinds of sedative and anesthesia techniques, 23 , 24 and it was significantly correlated with commonly used subjective clinical scales, 23 for example, the Ramsay sedation scale we used in this study. Interestingly, we observed significant lower BIS values in the PRD group during anesthesia, and higher sedation score right after extubation, which was consistent with the previous studies and indicates that intraoperative DEX provided a more stable anesthesia, without changing the hemodynamic characters.…”

Pre- or postoperative interscalene block and/or general anesthesia for arthroscopic shoulder surgery: a retrospective observational study

“…GA are not as pronounced as those of ISBPB alone. This is likely because of the adverse effects associated with GA. Less GA is required when an ISBPB is already active, 17,19 but there may still be some GAassociated adverse effects that can counteract the beneficial effects associated with ISBPB Only. This is supported by the fact that patients in the ISBPB Only group were discharged from the PACU almost 45 min earlier than those in the GA Only group.…”

Adverse heart rate responses during beach-chair position for shoulder surgeries - A systematic review and meta-analysis of their incidence, interpretations and associations

“…Our meta-analysis of HR-responses over time considered two sub-groups based on the type of anaesthesia and maintenance agents used. BL-HR was reported in 48 SGs ( n = 1334); 12 used TIVA-propofol[ 16 33 34 35 36 37 ] (73.7 ± 13.4 beats/min, n = 451), 33 received inhaled anaesthetics[ 16 29 35 38 39 40 41 42 43 44 45 46 47 48 49 50 ] (73.6 ± 13.6 beats/min, n = 744) and 139 subjects had ISB. [ 6 50 ] MDs between HR-values at supine (Pre-BCP) and post-BCP status are depicted in Figure 4 .…”

“…Sensitivity analysis revealed that various anaesthetic agents significantly influenced fall in HRs. However, it made little difference to the overall results when study controls[ 29 30 33 34 35 37 39 40 41 42 43 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 ] and randomised trials[ 4 6 12 13 15 16 26 27 28 29 30 33 34 35 37 38 39 41 42 44 45 46 47 50 55 60 61 64 ] were analysed separately [ Table 2 ]. Meta-regression was performed since primary outcomes, characterised by significant heterogeneity, yielded statistically significant omnibus P values for statistical models considering different maintenance agents and opioids.…”