Randomised comparison between superior trunk and costoclavicular blocks for arthroscopic shoulder surgery

Jo, Yumin; Oh, Chahyun; Lee, Woo Yong; Chung, Hyung-Jin; Park, Juyeon; Kim, Chongam; Ko, Youngkwon; Chung, Woosuk; Hong, Boohwi

doi:10.1097/eja.0000000000001735

Cited by 5 publications

(11 citation statements)

References 28 publications

(64 reference statements)

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“…However, the promising results of CCB in shoulder surgery do not seem to be reliably reproduced in our clinical experience [6]. In our previous report, the analgesic efficacy of CCB was not consistent, and a few patients required rescue blockades due to severe pain immediately after surgery.…”

Section: Introductionmentioning

confidence: 58%

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Effect of local anesthetic volume (20 vs. 40 ml) on the analgesic efficacy of costoclavicular block in arthroscopic shoulder surgery: a randomized controlled trial

Jo,

Oh,

Lee

et al. 2024

Korean J Anesthesiol

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Background: Among the various diaphragm-sparing alternatives to interscalene block, costoclavicular block (CCB) demonstrated a low hemidiaphragmatic paresis (HDP) occurrence but an inconsistent analgesic effect in arthroscopic shoulder surgery. We hypothesized that a larger volume of local anesthetic for CCB could provide sufficient analgesia by achieving sufficient supraclavicular spreading.Methods: Sixty patients scheduled for arthroscopic rotator cuff repair were randomly assigned to receive CCB using one of two volumes of local anesthetic (CCB20, 0.75% ropivacaine 20 ml; CCB40, 0.375% ropivacaine 40 ml). The primary outcome was the rate of complete analgesia (0 on the numeric rating scale of pain) at 1 h postoperatively. The secondary outcomes included a sonographic assessment of local anesthetic spread, diaphragmatic function, pulmonary function, postoperative opioid use, and other pain-related experiences within 24 h postoperatively. Results: The rates of complete analgesia were not significantly different (23.3% [7/30] and 33.3% [10/30] in the CCB20 and CCB40 groups, respectively; risk difference 10%, 95% CI [–13, 32], P = 0.567). There were no significant differences in other pain-related outcomes. Among the clinical factors considered, the only factor significantly associated with postoperative pain was the sonographic observation of supraclavicular spreading. There were no significant differences in the incidence of HDP and the change in pulmonary function between the two groups.Conclusions: Using 40 ml of local anesthetic does not guarantee supraclavicular spread during CCB. Moreover, it does not result in a higher rate of complete analgesia compared to using 20 ml of local anesthetic in arthroscopic shoulder surgery.

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Section: Introductionmentioning

confidence: 58%

“…In a preliminary analysis of our previous study [6], it was observed that approximately 70% of the patients reported a pain score greater than 0 at rest 1 h postoperatively after CCB when 20 ml of local anesthetic was used. We expected that using 40 ml of local anesthetic would demonstrate the incidence of any pain by up to 20%.…”

Section: Discussionmentioning

confidence: 98%

Effect of local anesthetic volume (20 vs. 40 ml) on the analgesic efficacy of costoclavicular block in arthroscopic shoulder surgery: a randomized controlled trial

Jo,

Oh,

Lee

et al. 2024

Korean J Anesthesiol

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“…Among the 414 patients in the RCTs, 203 and 211 patients underwent CCB and other BPB techniques, respectively. The other BPB techniques included supraclavicular block (n = 3) [ 6 , 7 , 29 ], interscalene block (n = 1) [ 27 ], lateral sagittal block (n = 1) [ 26 ], superior trunk block (n = 1) [ 28 ], and paracoracoid block (n = 1) [ 8 ]. Table 1 shows detailed information regarding the seven included studies.…”

Section: Resultsmentioning

confidence: 99%

“…The incidence of HDP was significantly lower in the CCB group than in the other BPB group (5.9% vs. 31.3%, six studies; RR: 0.21, 95% CI [0.12, 0.36], P < 0.001, I 2 = 47%; fixed-effect model) ( Fig. 4 ) [ 6 – 8 , 26 – 28 ]. The re-estimated RR in the sensitivity analysis retained statistical significance ( Supplementary Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Table 2 summarizes the pooled effect sizes for the secondary outcomes. Patients in three studies underwent postoperative pulmonary function tests [ 6 , 7 , 28 ], with all three studies reporting the peak expiratory flow rate (PEFR). The CCB group showed significantly higher PEFR values than the other BPB group (MD: 0.68 L/s, 95% CI [0.13, 1.23], P = 0.015, I 2 : 0%; fixed-effect model) ( Supplementary Fig.…”

Section: Resultsmentioning

confidence: 99%

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Hemidiaphragmatic paralysis after costoclavicular approach versus other brachial plexus blocks in upper limb surgery: a meta-analysis

Koo¹,

Hwang²,

Shin³

et al. 2023

Korean J Anesthesiol

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Background: The costoclavicular brachial plexus block (CCB) is a recently established technique that uses the infraclavicular approach and is performed just below the clavicle. This meta-analysis aimed to determine whether CCB can reduce the incidence of hemidiaphragmatic paralysis (HDP), which is a major adverse event related to brachial plexus block (BPB), while yielding comparable block performance as other BPB techniques.Methods: We searched electronic databases to identify relevant studies that compared the incidence of HDP between CCB and other BPB techniques. The primary outcome was the incidence of HDP following CCB and other BPB techniques. The secondary outcomes were pulmonary function test results, other adverse events, and block performance parameters such as onset and performance time. Results: We included six randomized controlled trials that included 414 patients. Compared with the other BPB group, the CCB group had a significantly lower incidence of HDP (relative ratio: 0.21, 95% CI [0.12, 0.36], P < 0.001) and higher peak expiratory flow rate (mean difference: 0.68 L/s, 95% CI [0.13, 1.23], P = 0.015). There were no significant between-group differences with respect to other adverse events and block performance parameters.Conclusions: Compared with other BPB techniques, CCB involves a lower incidence of HDP with comparable onset and performance time.

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Diaphragm-sparing efficacy of subparaneural upper trunk block for arthroscopic shoulder surgery

Jo,

Oh,

Lee

et al. 2024

European Journal of Anaesthesiology

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BACKGROUND Inter-scalene block (ISB) is associated with an inevitable risk of hemi-diaphragmatic paresis (HDP). To reduce the risk of HDP, an upper trunk block (UTB) has been proposed at the brachial plexus division level. OBJECTIVE We hypothesised that UTB would be associated with a lower incidence of HDP than ISB while providing sufficient analgesia following arthroscopic shoulder surgery. DESIGN Randomised controlled trial. SETTING A tertiary teaching hospital. PATIENTS Seventy patients aged 20 to 80 years undergoing arthroscopic rotator cuff repair. INTERVENTION Ultrasound-guided ISB or UTB was performed with 5 ml 0.75% ropivacaine. MAIN OUTCOME MEASURES The primary outcome was the incidence of complete HDP, assessed by diaphragm excursion using ultrasound, defined as a decrease to 25% or less of baseline or occurrence of paradoxical movement. Postoperative pulmonary function change, pain scores, opioid consumption and pain-related outcomes were the secondary outcomes. RESULTS The UTB group had a significantly lower incidence of complete HDP than the ISB group [5.9% (2/34) vs. 41.7% (15/36); absolute difference, 35.8%; 95% confidence interval (CI), 17.8 to 53.7%; P < 0.001]. The postblockade decline in pulmonary function was more pronounced in the ISB group than that in the UTB group. The pain score at 1 h postoperatively was not significantly different between the groups (ISB vs. UTB group: median 0 vs. 1; median difference, −1; 95% CI, −2 to 0.5). No significant difference was observed in any other secondary outcomes. CONCLUSION UTB was associated with a lower incidence of HDP compared with ISB while providing excellent analgesia in arthroscopic shoulder surgery. TRIAL REGISTRATION Clinical Trial Registry of Korea (https://cris.nih.go.kr) identifier: KCT0007002. IRB NUMBER Chungnam National University Hospital Institutional Review Board No. 2021-12-069.

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Randomised comparison between superior trunk and costoclavicular blocks for arthroscopic shoulder surgery

Cited by 5 publications

References 28 publications

Effect of local anesthetic volume (20 vs. 40 ml) on the analgesic efficacy of costoclavicular block in arthroscopic shoulder surgery: a randomized controlled trial

Effect of local anesthetic volume (20 vs. 40 ml) on the analgesic efficacy of costoclavicular block in arthroscopic shoulder surgery: a randomized controlled trial

Hemidiaphragmatic paralysis after costoclavicular approach versus other brachial plexus blocks in upper limb surgery: a meta-analysis

Diaphragm-sparing efficacy of subparaneural upper trunk block for arthroscopic shoulder surgery

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