Randomised controlled trial of analgesic effectiveness of three different techniques of single-shot interscalene brachial plexus block using 20 mL of 0.5% ropivacaine for shoulder arthroscopy

Stasiowski, Michał; Kolny, Michał; Zuber, Marek; Marciniak, Radosław; Chabierska, Ewa; Jałowiecki, Przemysław; Pluta, Aleksandra; Możdżyński, Bartłomiej

doi:10.5603/ait.a2017.0031

Cited by 12 publications

(7 citation statements)

References 27 publications

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“…Based on the evidence of the increasingly relevant deep fasciae role in connection to regional anaesthesiology, and given the growing interest in fascial plane, inter-fascial and nerve blocks, it can be reported that the exact thickness of a patient’s arm and forearm fasciae reduces the risk of nerve damage during these procedures [ 1 ]. Furthermore, understanding the thickness of the brachial and antebrachial fasciae is crucial for the fascial plane blocks, influencing the deposit and spread of local anesthetic, not only in the effectiveness of the blocks (i.e., onset time and area of anesthesia) [ 29 ], but also in the postoperative analgesia [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Imaging of Brachial and Antebrachial Fasciae

et al. 2021

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Knowledge about fasciae has become increasingly relevant in connection to regional anesthesiology, given the growing interest in fascial plane, interfascial, and nerve blocks. Ultrasound (US) imaging, thanks to high definition, provides the possibility to visualize and measure their thickness. The purpose of this study was to measure and compare, by US imaging, the thickness of deep/muscular fasciae in different points of the arm and forearm. An observational study has been performed using US imaging to measure brachial and antebrachial fasciae thickness at anterior and posterior regions, respectively, of the arm and forearm at different levels with a new protocol in a sample of 25 healthy volunteers. Results of fascial thickness revealed statistically significant differences (p < 0.0001) in the brachial fascia between the anterior and the posterior regions; in terms of the antebrachial fascia, no statistically significant difference was present (p > 0.05) between the regions/levels. Moreover, regarding the posterior region/levels, the brachial fascia had a greater thickness (mean 0.81 ± 0.20 mm) than the antebrachial fascia (mean 0.71 ± 0.20 mm); regarding the anterior region/levels, the antebrachial fascia was thicker (mean 0.70 ± 0.2 mm) than the brachial fascia (mean 0.61 ± 0.11 mm). In addition, the intra-rater reliability reported good reliability (ICC2,k: 0.88). US imaging helps to improve grading of fascial dysfunction or disease by revealing subclinical lesions, clinically invisible fascial changes, and one of the US parameters to reliably evaluate is the thickness in the different regions and levels.

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Section: Discussionmentioning

confidence: 99%

Ultrasound Imaging of Brachial and Antebrachial Fasciae

et al. 2021

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“…A different question is whether the addition of nerve stimulation to ultrasound guidance offers any advantage for nerve block procedures. Results appear to be consistent across femoral nerve block [25, 26], interscalene brachial plexus block [27], infraclavicular brachial plexus block [28], and popliteal sciatic nerve block [29] techniques, as data show no difference in block success and/or pain scores. This suggests that for nerve targets that are relatively easy to view, nerve stimulation may not confer an additional advantage when used with ultrasound guidance.…”

Section: Nerve Stimulation Vs Ultrasound For Nerve Localisationmentioning

confidence: 83%

The role of peripheral nerve stimulation in the era of ultrasound‐guided regional anaesthesia

Gadsden

2021

Anaesthesia

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Summary With the widespread use of ultrasound for localising nerves during peripheral nerve blockade, the value of electrical nerve stimulation of evoked motor responses has been questioned. Studies continue to show that, compared with nerve stimulation, ultrasound guidance alone leads to: significantly improved block success; decreased need for rescue analgesia; decreased procedural pain; and lower rates of vascular puncture. Nerve stimulation combined with ultrasound does also not appear to improve block success rates, apart from those blocks where the nerves are challenging to view, such as the obturator nerve. The role of nerve stimulation has changed in the last 15 years from a technique to locate nerves to that of an adjunct to ultrasound. Nerve stimulation can serve as a monitor against needle‐nerve contact and may be useful in avoiding nerves that are in the needle trajectory during specific ultrasound guided techniques. Nerve stimulation is also a useful adjunct in teaching novices ultrasound‐guided regional anaesthesia, especially when the position and or appearance of nerves may be variable. In this review, the changing role of nerve stimulation in contemporary regional anaesthetic practice is presented and discussed.

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“…This emphasizes the safety of the anesthetic regimen used in this study for intra- and postoperative anesthesia in these patients. The use of ultrasound guidance for the detection of the end of the needle was abandoned on purpose because it was reported to have no impact on the time of duration of the sensory block as compared to ultrasound guidance or dual guidance [23]. Additionally, the procedures were performed by the same anesthesiologist which compensates for a decreased accuracy regarding the site of injection and therefore an increased variability of drug dispersion during the nerve block.…”

Section: Discussionmentioning

confidence: 99%

Addition of 100 mg of Tramadol to 40 mL of 0.5% Ropivacaine for Interscalene Brachial Plexus Block Improves Postoperative Analgesia in Patients Undergoing Shoulder Surgeries as Compared to Ropivacaine Alone—A Randomized Controlled Study

et al. 2019

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Background and objectives: Brachial plexus block is commonly used in shoulder surgery, as it provides satisfactory surgical conditions and adequate postoperative pain control. However, there are contradictory reports regarding the addition of tramadol to the injected regional anesthetic solution. We performed a prospective randomized study to evaluate the effectiveness of tramadol as an adjuvant to ropivacaine during interscalene brachial plexus block and assess its impact on the opioid consumption and the early postoperative pain in patients that underwent shoulder surgery. Materials and Methods: Eighty patients scheduled for elective shoulder surgery and anesthesia via interscalene brachial plexus block were randomly divided into two groups. In group A (n = 40), a solution of 40 mL of ropivacaine 0.5% and 2 mL (100 mg) of tramadol was administered during the brachial plexus block, while in group B (n = 40), a solution of 40 mL of ropivacaine 0.5% and 2 mL NaCl 0.9% (placebo) was administered. The effectiveness and duration of sensory and motor blocks were recorded in both groups. The sensory block was assessed recording the loss of sensation to pin prick test over the skin distribution of the axillary, radial, and musculocutaneous nerves. The motor block was assessed using the modified 3-point Bromage score (0–2 points). Cumulative morphine consumption and pain, using the Visual Analog Scale (VAS), were evaluated in both groups at 2, 4, 8, and 24 h after surgery. Results: Sensory block onset was achieved earlier in group A than in group B (5.21 ± 3.15 minutes (min) vs. 7.1 ± 4.51 min, p = 0.029). The motor block onset was similar between the two groups (13.08 ± 6.23 min vs. 13.28 ± 6.59 min; p = 0.932). The duration of the sensory block was longer in group A as compared to group B (13 ± 2.3 h vs. 12 ± 2.8 h; p = 0.013). The duration of the motor block did not present any difference between the groups (10 ± 2.2 h vs. 10 ± 2.8 h; p = 0.308). Differences in morphine administration were not significant at 2, 4, and 8 h, however, morphine consumption was found to be decreased in group A 24 h postoperatively A (p = 0.04). The values of VAS were similar at 2, 4, and 8 h, however, they were lower in group A at 24 h (p < 0.013). Conclusions: Combined regional administration of tramadol and ropivacaine during interscalene brachial plexus block improves the time of onset and the duration of the sensory block, while it is associated with reduced morphine consumption during the first 24 h after shoulder surgery.

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Randomised controlled trial of analgesic effectiveness of three different techniques of single-shot interscalene brachial plexus block using 20 mL of 0.5% ropivacaine for shoulder arthroscopy

Cited by 12 publications

References 27 publications

Ultrasound Imaging of Brachial and Antebrachial Fasciae

Ultrasound Imaging of Brachial and Antebrachial Fasciae

The role of peripheral nerve stimulation in the era of ultrasound‐guided regional anaesthesia

Addition of 100 mg of Tramadol to 40 mL of 0.5% Ropivacaine for Interscalene Brachial Plexus Block Improves Postoperative Analgesia in Patients Undergoing Shoulder Surgeries as Compared to Ropivacaine Alone—A Randomized Controlled Study

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