Effect of intravenous ondansetron on reducing the incidence of hypotension and bradycardia events during shoulder arthroscopy in sitting position under interscalene brachial plexus block: A prospective randomized trial

Abstract

Background and Aims:Sudden, profound hypotension and bradycardia events (HBEs) have been reported in more than 20% of patients undergoing shoulder arthroscopy in the sitting position. The present study was designed to know whether intravenous (IV) ondansetron (selective 5-hydroxy tryptamine 3-antagonist) can help in reducing the HBEs associated with shoulder arthroscopy performed in sitting position under interscalene brachial plexus block (ISBPB).Methods:A total of 100 patients (age 20–50 years) undergoing shoulder arthroscopy performed in the sitting position under ISBPB were assigned randomly to one of the two groups: Group C received 10 ml of normal saline and Group T received 4 mg of ondansetron diluted in 10 ml of normal saline` IV. All patients received ISBPB using levobupivacaine 0.5%. Assessment of motor and sensory blockade, pulse rate, systolic blood pressure, respiration, and side effects were noted every 5 min for first 30 min and every 10 min till the end of surgery. HBEs were recorded in both groups.Results:IV injection of ondansetron significantly reduces the incidence of HBEs from 11 (22.44% in Group C) to 3 (6.1% in Group T). The duration of analgesia was significantly longer in Group C (8.1 ± 3.3) in comparison with Group T (6.3 ± 4.2 h).Conclusion:We conclude that 4 ml of IV ondansetron can significantly reduce the HBEs during shoulder arthroscopy done in the sitting position under ISBPB.

Effect of brachial plexus block on the incidence of arterial hypotension and bradycardia events during shoulder arthroscopy in adolescents

“…Использование одансетрона, по данным S. Nallam (2015), позволило снизить АГБ с 22,44 до 6,1 % [11], а профилактическое назначение β-блокаторов (5 мг метопролола), по данным G.A. Liguori (1998), -с 28 до 5 % (p = 0,004) [10].…”

“…Интраоперационное введение фентанила, по нашим данным, не влияло на частоту развития АГБ. Такие же результаты получили S. Nallam и S. Dara (2015) [11]. Мы не отметили статистической разницы между правосторонним и левосторонним доступами к плечевому сплетению в отличие от K. Seo et al (2010) [6] и M. Simeoforidou et al (2013) [16].…”

“…В частности, известно, что синдром АГБ развивается на фоне избыточной седации и использования фентанила [6,7], при добавлении адреналина в раствор местного анестетика или в ирригационный раствор [2,8,9], при выполнении блокады с правой стороны [6]. Многие авторы при МБПС использовали метод парестезий, либо фасцикуляций, в ответ на нейростимуляцию и применяли значительные (от 30,0 до 50,0 мл) объемы местных анестетиков [3,10,11]. Нам известно только одно исследование, в кото-ром нейростимуляцию сочетали с ультразвуковой (УЗ) навигацией и при этом объем местных анестетиков составлял 13-18 мл [2].…”

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

“…[ 9 10 11 ] Similarly, the association of use of β-adrenergic agonists and adverse heart rate (HR)-responses/HBE[ 2 4 ] is uncertain since these episodes were also reported in patients without their use. [ 12 13 ] Likewise, while ISB has been linked to such events,[ 8 ] the same has not been confirmed with general anaesthesia (GA). There is a paucity of comparative literature on the association of HR-responses in BCP with other parameters like use of maintenance anaesthetic agents or opioids.…”

Shoulder arthroscopy and complications: Can we afford to relax?

“…[ 2 ] Bezold–Jarisch reflex can also be triggered by activation of 5HT 3 receptors. Srinivasa Rao Nallam et al , in their study published in this issue of IJA,[ 13 ] report that pre-treatment with intravenous ondansetron (5HT 3 receptors blocker) reduces the incidence of HBE when interscalene brachial block and sitting position were used in shoulder arthroscopy.…”