Comparison of the Haemodynamic Effects of Interscalene Block Combined with General Anaesthesia and Interscalene Block Alone for Shoulder Surgery

Abstract

Interscalene brachial plexus block (ISB) anaesthesia is widely used with or without general anaesthesia in patients undergoing shoulder surgery, which is generally done with the patient in a sitting position. This position affects haemodynamics, and supplementing ISB with general anaesthesia can exaggerate these haemodynamic changes. This study compared ISB combined with general anaesthesia, with ISB alone, in 29 patients undergoing elective shoulder surgery. Heart rate and oxygen saturation remained stable throughout the study in both groups. Mean arterial pressure was significantly decreased when the patient moved into the sitting position in those given combined anaesthesia, whereas in those given ISB alone mean arterial pressure did not change significantly. Neither pain scores nor patient satisfaction scores differed significantly between the two groups. All of the patients were either satisfied or entirely satisfied with their anaesthesia/analgesia. There were no significant differences in side-effects and no severe complications in either group. We advocate using ISB alone for patients undergoing shoulder surgery, but further larger studies are needed to confirm the present results.

Blood pressure response to combined general anaesthesia/interscalene brachial plexus block for outpatient shoulder arthroscopy

“…We take this as evidence that the observed hypotension was related to setting the patient in the semi-upright position soon after the induction dose of propofol [6], since most treatment events were triggered by a decrease of systolic blood pressure after induction of anaesthesia. In a similar, smaller study on younger patients, in which all patients had an ISB while one group had an additional general anaesthetic, Ozzeybek et al found that the combination of the two techniques caused a significantly greater decrease in arterial blood pressure than the ISB alone [9]. …”

“…Such a difference that persists past the duration of action of mepivacaine could be evidence of a pre-emptive effect of the regional anaesthesia [4]. Ozzeybek et al [9] studied the course of postoperative pain severity in patients undergoing shoulder surgery under general anaesthesia with ISB. However, since the authors failed to give the actual pain scores, it is not possible to compare their results with those in our corresponding GA-ISB group.…”

“…Haemodynamic stability has been studied individually for each technique as well as for the combination of the two [7,9-11], but with the exception of one small study [9], there is no systematic investigation comparing the incidence and severity of hypotensive events under general anaesthesia alone and general anaesthesia plus interscalene block.…”

Evaluation of the success of supraclavicular blockade performed under general anesthesia in arthroscopic surgery of the shoulder by using Perfusion Index

“…Systemic hemodynamic parameters are not affected in the blockade of peripheral nerves of upper extremity [3,[24][25][26]. Therefore, they are important in balanced anesthetic procedures.…”

The Cardiac Function in the Beach Chair Position under General Anesthesia

“…Moving into an upright position activates the sympathetic nervous system, resulting in an increase in the systemic vascular resistance (SVR) and the systemic BP and a reduction in the cardiac output (CO) [11]. In contrast, the upper extremity mABP and SctO 2 values are significantly decreased when the position of an anesthetized patient is changed to the BCP [8] [9] [10] [12]. It has been suggested that the hydrostatic pressure gradient between the brain and the upper extremities plays a role in the decrease in the brain BP that is observed when anesthetized patients are placed into the BCP and that the SctO 2 value decreases due to cerebral hypoperfusion [8] [9].…”