Interscalene brachial plexus block combined with total intravenous anaesthesia and laryngeal mask airway for shoulder surgery

Grossi, Paolo; Calliada, S; Braga, Angélica de Fátima de Assunção; Caldara, P; D'Aloia, Alfonso; Coluccia, Renato

doi:10.1111/j.1365-2044.1998.tb15138.x

Cited by 5 publications

(4 citation statements)

References 3 publications

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“…The time required for performing the ISB was similar to times described in the literature [15,16]. The duration of the operation was significantly shorter in the group with the ISB, which in is accordance with published reports [15,17,18].…”

Section: Discussionsupporting

confidence: 90%

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

Janssen

Stosch²,

Pöschl³

et al. 2014

BMC Anesthesiol

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BackgroundShoulder surgery is often performed in the beach-chair position, a position associated with arterial hypotension and subsequent risk of cerebral ischaemia. It can be performed under general anaesthesia or with an interscalene brachial plexus block, each of which has specific advantages but also specific negative effects on blood pressure control. It would be worthwhile to combine the advantages of the two, but the effects of the combination on the circulation are not well investigated. We studied blood pressure, heart rate, and incidence of adverse circulatory events in patients undergoing shoulder surgery in general anaesthesia with or without an interscalene block.MethodsProspective, randomised, blinded study in outpatients (age 18 to 80 years) undergoing shoulder arthroscopy. General anaesthesia was with propofol/opioid, interscalene block with 40 ml 1% mepivacaine. Hypotension requiring treatment was defined as a mean arterial pressure <60 mmHg or a systolic pressure <80% of baseline; relevant bradycardia was a heart rate <50 bpm with a decrease in blood pressure.ResultsForty-two patients had general anaesthesia alone, 41 had general anaesthesia plus interscalene block. The average systolic blood pressure under anaesthesia in the beach-chair position was 114 ± 7.3 vs. 116 ± 8.3 mmHg (p = 0.09; all comparisons General vs. General-Regional). The incidence of a mean arterial pressure under 60 mmHg or a decrease in systolic pressure of more than 20% from baseline was 64% vs. 76% (p = 0.45). The number of patients with a heart rate lower than 50 and a concomitant blood pressure decrease was 8 vs. 5 (p = 0.30).ConclusionOne can safely combine interscalene block with general anaesthesia for surgery in the beach-chair position in ASA I and II patients.Clinical trial numberDRKS00005295.

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Section: Discussionsupporting

confidence: 90%

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

Janssen

Stosch²,

Pöschl³

et al. 2014

BMC Anesthesiol

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“…Anaesthesia in shoulder surgery order to obtain better security, comfort and satisfaction of patients. 10,16 Our results clearly indicate that these goals can be achieved with ISB alone. In view of the definite advantages of using ISB alone, such as early detection of air embolism and reduced costs, we advocate ISB alone for patients undergoing shoulder surgery in which haemodynamic changes are particularly important, but further larger studies are needed to confirm this.…”

Section: Discussionsupporting

confidence: 53%

“…Several studies have demonstrated that intraoperative ISB alone decreases postoperative pain, nausea, vomiting and urinary retention, and increases patient satisfaction compared with GA alone. 2,6, 15 Grossi et al 16 suggested that supplementing ISB with GA avoids the stress experienced by the patient who is awake while undergoing surgery. Inadequate sedation might result in the patient complaining of noise or discomfort from prolonged immobility and will not compensate for an inadequate block.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2003

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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.

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“…Similarly, Chelly et al demonstrated that ISB alone was safe and effective and could contribute to shortening the duration of hospital stays [ 21 ]. In contrast, Grossi et al reported that patients who were awake while undergoing surgery by supplementing ISB with GA experienced less stress [ 22 ]. In our study, the effects of desflurane were terminated as soon as possible because of this agent’s quick wash-out.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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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

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Interscalene brachial plexus block combined with total intravenous anaesthesia and laryngeal mask airway for shoulder surgery

Cited by 5 publications

References 3 publications

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

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

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

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

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