Effect of an epinephrine mixture for interscalene block on hemodynamic changes after the beach chair position under general anesthesia: a retrospective study

Abstract

BackgroundThe beach chair position (BCP) can cause significant hypotension. Epinephrine is used to prolong the duration of local anesthetics; it is also absorbed into blood and can exert systemic effects. This study determined the effects of epinephrine mixed with ropivacaine for an interscalene block (ISB) on hemodynamic changes related to BCP.MethodsPatient data collected from March 2013 to August 2014 were used retrospectively. We divided the patients into three groups: 1) ISB only, 2) I+G (general anesthesia after ISB without epinephrine), and 3) I+E+G (general anesthesia after ISB with epinephrine). Mean blood pressure (MBP) and heart rate (HR) were measured for 30 minutes at 5-minute intervals.ResultsThe study analyzed data from 431 patients. MBP tended to decrease gradually in the groups I+G and I+E+G. There were significant differences in MBP between the groups I+G and I, and between the groups I+G and I+E+G. Group I+E+G showed a significant increase in HR compared with the other two groups.ConclusionsISB with an epinephrine mixture did not prevent hypotension caused by the BCP after general anesthesia. HR increased only in response to the epinephrine mixture. A well-planned prospective study is required to compare hemodynamic changes in that context.

Effects of intraoperative hypotension on postoperative renal function in arthroscopic shoulder surgery: a retrospective study

“…Blood pressure naturally drops after general anesthesia in the beach chair posture. Therefore, if the operation is performed under general anesthesia, large amounts of vasopressors are needed, and if the operation is performed only with interscalene block and sedation, large amounts of blood pressure-lowering agents, such as nicardipine, are needed [11]. These observations raise questions regarding the appropriate blood pressure for shoulder arthroscopy when the patient is in the beach chair posture.…”