Randomized, comparative study of the effectiveness of three different techniques of interscalene brachial plexus block using 0.5% ropivacaine for shoulder arthroscopy

Abstract

Background: Interscalene brachial plexus block is an effective regional anesthesia technique for shoulder surgeries. The superiority of the popular ultrasound-guided blocks over peripheral nerve stimulator-confirmed blocks remains unclear. In this study the efficacy of these different block techniques was compared. Methods: This prospective, randomized, clinical study included 109 patients (ASA grades I-III) who receive 20 mL 0.5% ropivacaine with ultrasound-guided blocks (U group), peripheral nerve stimulator-confirmed blocks (N group), or ultrasound-guided and peripheral nerve stimulator-confirmed blocks (dual guidance; NU group) for elective shoulder arthroscopy. Block onset time, duration, and effectiveness on the Lovett rating scale were assessed. Results: There was no statistically significant intergroup difference in duration of block performance, irrespective of the technique (P = 0.232). Onset time of complete warmth sensation loss (P < 0.001) and muscle strength abolition (P < 0.001) was significantly longer and mean Lovett rating scale score distribution was significantly higher in the N group than in the other groups (P < 0.001). These findings show a statistically significant correlation between the performance of the used block technique and the necessity of conversion to general anesthesia because of insufficient block in the N group (58.54%) than in the U (24.44%) and NU (19.57%) groups. Conclusions: Peripheral nerve stimulator-confirmed needle placement is not necessary to ensure effectiveness of ultrasound-guided blocks, which is expressed as a lack of necessity of conversion to general anesthesia. Nevertheless, the dual guidance technique is recommended to reduce the risk of complications and might be considered the regional anesthesia of choice for shoulder surgery.

Adverse Events during Vitrectomy under Adequacy of Anesthesia—An Additional Report

“…Additionally, various methods of preventive analgesia (PA) for PPV, such as regional techniques [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ], and intravenous techniques with preoperative infusion of COX-3 inhibitors (paracetamol, metamizole) [ 21 , 22 ], were shown to provide adequate postoperative analgesia [ 17 ], with a fall in the rate of main adverse events [ 12 , 15 , 23 ] within the mechanism of a reduction in demand for IO.…”

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

“…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. The use of the high volume of 40 mL of local anesthetic was responsible for the impressive high success rate in successful blocks according to the current literature, because reduction of volume to 20 mL results in the necessity of conversion to general anesthesia because of insufficient block in 58.54% of cases where only perineural stimulator is used [24]. Although a high volume of ropivacaine (40 mL) was used, only 11 patients experienced Horner’s syndrome, what is relatively low as compared to the current literature [25].…”

Effect of topical or peribulbar analgesia on the incidence of oculocardiac reflex, postoperative pain and postoperative nausea and vomiting following vitreoretinal surgery under surgical pleth index-guided general anaesthesia.

“…This may play a key role in the utility of SPI guidance for supplemental FNT administration. Introduction of ultrasound-guided, perineural stimulation-directed (dual guidance) interscalene BPB increased its efficacy from 41.46% with the perineural stimulation technique to 80.43% with the dual guidance technique [24]. Hopefully, similar to dual guidance BPB, ultrasound-guided PBB combined with GA in patients undergoing VRS may in the future [50], improve the efficacy of PBB by more precise needle placement and observation of LA deposition at the target destination.…”

“…Attempts have been made to reduce the dose of intraoperative OA with different techniques of preventive analgesia for VRS. Reduction in the intravenous dose of OA administered intraoperatively with a combination of GA and regional techniques, including preoperative peribulbar block (PBB) [22,23,24,25,26], retrobulbar block (RBB) [27,28], subtendon block [29,30] and topical anaesthesia (TA) [31] have been proven to provide adequate analgesia postoperatively [28], with reduced incidence of OCR [32] and PONV [23,26], despite potential side effects [3].…”