Continuous interscalene versus phrenic nerve-sparing high-thoracic erector spinae plane block for total shoulder arthroplasty: a randomized controlled trial

Abstract

Purpose The high-thoracic erector spinae plane block (HT-ESPB) has been reported as an effective analgesic modality for the shoulder region without phrenic nerve palsy. The goal of this study was to compare the HT-ESPB as a phrenic nerve-sparing alternative to an interscalene block for total shoulder arthroplasty. Methods Thirty patients undergoing total shoulder arthroplasty at Stanford Health Care

Optimizing Local Anesthetic Technique for Clavicular Surgeries: Issues Should Be Noticed

“…Most important, this study did not assess postoperative outcomes of patients, such as the duration of postanesthesia care unit (PACU) stay, quality of recovery, and time to discharge, as performed in the same work. 5,6 Thus, an important issue that this cannot answer is whether hemidiaphragmatic paralysis by the combined ISBPB with ICPB technique should be considered as being a clinically important event.…”

A randomised controlled trial in patients undergoing arthroscopic shoulder surgery comparing interscalene block with either 10 ml or 20 ml levobupivacaine 0.25%

“…This indicates that 10 ml of levobupivacaine 0.25% anaesthetises the brachial plexus as much as 20 ml while affecting the phrenic nerve less. The effects of alternatives to interscalene blockade on the phrenic nerve have been investigated [14, 19, 32–34]. We think that alternative blocks for shoulder surgery may not be needed if the dose of interscalene local anaesthetic is moderated, which would help anaesthetists become adept by practising fewer types of block [35].…”

Erector spinae block: beyond the torso

“…The authors noted that cumulative opioid consumption was significantly higher on the day of surgery, with a trend to slightly higher pain scores during the same period in the ESP catheter group. They concluded that high thoracic ESP catheters provide reasonable analgesia in shoulder arthroplasty and have the advantage of being both phrenic and motor-sparing [18 ▪▪ ]. The place of thoracic or cervical ESP blocks in shoulder surgery may thus be in select patient groups where phrenic nerve or motor sparing is a priority, or direct injection around the brachial plexus is not feasible.…”

“…by an interscalene or superior trunk block. There have been two recent RCTs comparing high thoracic ESP blocks to periarticular injection (PAI) and interscalene block (ISB) in shoulder surgery [17 ▪▪ ,18 ▪▪ ]. In the PAI study, the investigators were unable to demonstrate superiority of ESP blocks over PAI in arthroscopic shoulder surgery, with both groups having similar patient satisfaction scores, pain scores and opioid consumption [17 ▪▪ ].…”

“…In the PAI study, the investigators were unable to demonstrate superiority of ESP blocks over PAI in arthroscopic shoulder surgery, with both groups having similar patient satisfaction scores, pain scores and opioid consumption [17 ▪▪ ]. The second study compared ISB and ESP catheters in patients undergoing total shoulder arthroplasty, with the primary aim of evaluating the incidence of hemidiaphragmatic paresis [18 ▪▪ ]. None of the ESP patients had any ultrasonographic evidence of hemidiaphragmatic paresis; whereas this was present in all ISB patients.…”