Successful Continuous Interscalene Analgesia for Ambulatory Shoulder Surgery in a Private Practice Setting

Fredrickson, Michael J.; Ball, Craig M.; Dalgleish, Adam J.

doi:10.1097/00115550-200803000-00006

Cited by 92 publications

(29 citation statements)

References 10 publications

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“…The strongest evidence from RCTs shows the ability of interscalene catheters to decrease resting and dynamic pain, opioid requirements and opioid-related side effects, and sleep disturbances after moderately to severely painful shoulder surgery. 124,133 Similar benefit has been demonstrated for ambulatory continuous infusions via the interscalene 126,133,193,194 and infraclavicular approaches. 128,132,195,196 In experienced hands, these techniques are remarkably successful, 197 providing analgesia in 99% of patients 63 and improving rehabilitation and readiness for hospital discharge after total joint arthroplasty in most 128,133,143 but not all studies.…”

Section: Continuous Perineural Catheter Blocksmentioning

confidence: 83%

Upper Extremity Regional Anesthesia

Neal¹,

Gerancher

Hebl

et al. 2009

Regional Anesthesia and Pain Medicine

305

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Brachial plexus blockade is the cornerstone of the peripheral nerve regional anesthesia practice of most anesthesiologists. As part of the American Society of Regional Anesthesia and Pain Medicine's commitment to providing intensive evidence-based education related to regional anesthesia and analgesia, this article is a complete update of our 2002 comprehensive review of upper extremity anesthesia. The text of the review focuses on (1) pertinent anatomy, (2) approaches to the brachial plexus and techniques that optimize block quality, (4) local anesthetic and adjuvant pharmacology, (5) complications, (6) perioperative issues, and (6) challenges for future research.Upper extremity regional anesthesia has been a mainstay of the anesthesiologist's armamentarium since Hall 1 first reported the use of cocaine to block the brachial plexus in 1884. Recognizing that upper extremity neural blockade represents the most frequent use of peripheral nerve blocks in most anesthesiologists' practice, 2 in 2001, the American Society of Regional Anesthesia and Pain Medicine (ASRA) undertook a critical review of all available English-language publications pertinent to this topic. The resulting extensive source document was synthesized into a comprehensive review article 3 that was published in 2002; both the source and the review documents will be updated approximately every 5 years.Rather than publishing only new material that has become available since 2002, the original review article has been completely revised so that readers may continue to view the subject matter in its entirety. New topics in this review include ultrasound-guided brachial plexus block, continuous catheter-based analgesia, and a collection of new images * by medical illustrator, Jennifer Gentry (www.gentryvisualization.com). This review summarizes the essential scholarly work available from the source document, which can be viewed at Copyright © 2009 by American Society of Regional Anesthesia and Pain Medicine Address correspondence to: Joseph M. Neal, MD, 1100 Ninth Ave (B2-AN), Seattle, WA 98101 (anejmn@vmmc.org). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of this entity. James P. Rathmell, MD, served as acting editor-in-chief for this article.Financial support: None. NIH Public Access Author ManuscriptReg Anesth Pain Med. Author manuscript; available in PMC 2010 March 1. Published in final edited form as:Reg Anesth Pain Med. 2009 ; 34(2): 134-170. doi:10.1097/AAP.0b013e31819624eb. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript www.asra.com. This review article strives (1) to serve as a review of pertinent anatomy, (2) to compare the effectiveness of brachial plexus approaches and techniques, (3) to present available evidence to guide selection of pharmacological agents, (4) to describe the complications inherent to upper extremity anesthesia, (5) to consider pertinent perioperative issues, and (6) to identify informational gaps and empha...

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Section: Continuous Perineural Catheter Blocksmentioning

confidence: 83%

Upper Extremity Regional Anesthesia

Neal¹,

Gerancher

Hebl

et al. 2009

Regional Anesthesia and Pain Medicine

305

View full text Add to dashboard Cite

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“…Our findings showed that FVC, FVC%, and FEV1 were significantly decreased following SCBPB with 20 mL or 30 mL 0.375% ropivacaine. Generally, patients do not experience difficulty breathing until the FVC falls to ≤38% of the predicted value because of physiological compensation,19 and evidence suggests that the majority of patients can tolerate20 the decreased lung function that results from phrenic nerve paralysis during interscalene brachial plexus block 21. However, this well-documented side effect is a contraindication to brachial plexus block in patients with pre-existing restrictive lung disease or severe obstructive lung disease 22 23.…”

Section: Resultsmentioning

confidence: 99%

Effect of local anesthetic volume (20 mL vs 30 mL ropivacaine) on electromyography of the diaphragm and pulmonary function after ultrasound-guided supraclavicular brachial plexus block: a randomized controlled trial

Bao

Huang

Feng

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesDiaphragmatic paralysis following supraclavicular brachial plexus block (SCBPB) is ascribed to phrenic nerve palsy. This study investigated the effect of 2 volumes of 0.375% ropivacaine on efficacy of block as a surgical anesthetic and as an analgesic and examined diaphragm compound muscle action potentials (CMAPs) and pulmonary function before and after SCBPB.MethodsEighty patients scheduled for removal of hardware for internal fixation after healing of an upper limb fracture distal to the shoulder were randomized to receive ultrasound-guided SCBPC for surgical anesthesia with 20 mL (Group A) or 30 mL (Group B) 0.375% ropivacaine. The latency and amplitude of diaphragm CMAPs and forced vital capacity (FVC), FVC% predicted, and forced expiratory volume in 1 s (FEV1) were measured before and 30 min after SCBPB.ResultsBlock success as primary anesthetic in addition to analgesia was 81% in Group A and 91% in Group B. There were no obvious differences in the effectiveness of analgesia between the two groups. The mean time to onset of motor block was significantly longer in Group A (8.1±2.7 min) than in Group B (5.4 ± 2.8 min; p<0.05). The mean amplitude of the diaphragm CMAP was significantly lower in Group B than in Group A (p=0.03). The changes in FVC (Group A, − 8.1% vs Group B, −16.5%), FVC% (Group A, −8.0% vs Group B, −17.1%), and FEV1 (Group A, −9.5% vs Group B, −15.2%) from pre-SCBPB to post-SCBPB were significantly less in Group A than in Group B (all p=0.03).ConclusionsThe incidence rates of phrenic nerve palsy and diaphragm paralysis were reduced, and lung function was less impaired in patients who received 20 mL vs 30 mL of 0.375% ropivacaine without any differences in block success. Selecting a lower volume of anesthetic for nerve block may be especially beneficial in obese patients or patients with cardiopulmonary disease.Trial registration numberChiCTR-IND-17012166.

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“…4,5 Recent technological advances such as ultrasound (US) 6Y8 and stimulating catheter designs have increased success rates for CPNBs. 6,7,9Y11 However, the potential for complications still exists.…”

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confidence: 99%