Ropivacaine for ultrasound-guided interscalene block: 5?mL provides similar analgesia but less phrenic nerve paralysis than 10?mL

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• 作者：Joon-Ho Lee MD ; PhD (1)
  Sung-Hwan Cho MD (1)
  Sang-Hyun Kim MD ; PhD (1)
  Won-Soek Chae MD ; PhD (1)
  Hee-Cheol Jin MD ; PhD (1)
  Jeong-Seok Lee MD ; PhD (1)
  Yong-Ik Kim MD ; PhD (1)
  
• 刊名：Canadian Journal of Anesthesia/Journal canadien d'anesth篓娄sie
• 出版年：2011
• 出版时间：November 2011
• 年：2011
• 卷：58
• 期：11
• 页码：1001-1006
• 全文大小：1711KB
• 参考文献：1. / Singelyn FJ, / Lhotel L, / Fabre B. Pain relief after arthroscopic shoulder surgery: a comparison of intraarticular analgesia, suprascapular nerve block, and interscalene brachial plexus block. Anesth Analg 2004; 99: 589-92. CrossRef
  2. / Long TR, / Wass CT, / Burkle CM. Perioperative interscalene blockade: an overview of its history and current clinical use. J Clin Anesth 2002; 14: 546-56. CrossRef
  3. / Winnie AP. Interscalene brachial plexus block. Anesth Analg 1970; 49: 455-66. CrossRef
  4. / Marhofer P, / Greher M, / Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth 2005; 94: 7-17. CrossRef
  5. / Kapral S, / Greher M, / Huber G, / et al. Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth Pain Med 2008; 33: 253-8.
  6. / Riazi S, / Carmichael N, / Awad I, / Holtby RM, / McCartney CJ. Effect of local anaesthetic volume (20 vs 5?ml) on the efficacy and respiratory consequences of ultrasound-guided interscalene brachial plexus block. Br J Anaesth 2008; 101: 549-56. CrossRef
  7. / Renes SH, / Rettig HC, / Gielen MJ, / Wilder-Smith OH, / van Geffen GJ. Ultrasound-guided low-dose interscalene brachial plexus block reduces the incidence of hemidiaphragmatic paresis. Reg Anesth Pain Med 2009; 34: 498-502. CrossRef
  8. / Wiener DN, / Speer KP. The deltoid sign. Anesth Analg 1994; 79: 192. CrossRef
  9. / Freedman B. Unilateral paralysis of the diaphragm and larynx associated with inflammatory lung disease. Thorax 1950; 5: 169-82. CrossRef
  10. / Al-Kaisy A, / McGuire G, / Chan VW, / et al. Analgesic effect of interscalene block using low-dose bupivacaine for outpatient arthroscopic shoulder surgery. Reg Anesth Pain Med 1998; 23: 469-73. CrossRef
  11. / Capdevila X, / Barthelet Y, / Biboulet P, / Ryckwaert Y, / Rubenovitch J, / d’Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology 1999; 91: 8-15. CrossRef
  12. / Rawal N, / Axelsson K, / Hylander J, / et al. Postoperative patient-controlled local anesthetic administration at home. Anesth Analg 1998; 86: 86-9.
  13. / Beaudet V, / Williams SR, / Tetreault P, / Perrault MA. Perioperative interscalene block versus intra-articular injection of local anesthetics for postoperative analgesia in shoulder surgery. Reg Anesth Pain Med 2008; 33: 134-8.
  14. / Borgeat A, / Schappi B, / Biasca N, / Gerber C. Patient-controlled analgesia after major shoulder surgery: patient-controlled interscalene analgesia versus patient-controlled analgesia. Anesthesiology 1997; 87: 1343-7. CrossRef
  15. / Houghton IT, / Aun CS, / Gin T, / Lau JT. Inter-ethnic differences in postoperative pethidine requirements. Anaesth Intensive Care 1992; 20: 52-5.
  16. / Lee A, / Gin T, / Oh TE. Opioid requirements and responses in Asians. Anaesth Intensive Care 1997; 25: 665-70.
  17. / Marhofer P, / Chan VW. Ultrasound-guided regional anesthesia: current concepts and future trends. Anesth Analg 2007; 104: 1265-9. CrossRef
  18. / O’Donnell BD, / Iohom G. An estimation of the minimum effective anesthetic volume of 2% lidocaine in ultrasound-guided axillary brachial plexus block. Anesthesiology 2009; 111: 25-9. CrossRef
  19. / Willschke H, / Marhofer P, / Bosenberg A, / et al. Ultrasonography for ilioinguinal/iliohypogastric nerve blocks in children. Br J Anaesth 2005; 95: 226-30. CrossRef
  20. / Urmey WF, / Talts KH, / Sharrock NE. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesth Analg 1991; 72: 498-503. CrossRef
  21. / Urmey WF, / McDonald M. Hemidiaphragmatic paresis during interscalene brachial plexus block: effects on pulmonary function and chest wall mechanics. Anesth Analg 1992; 74: 352-7. CrossRef
  
• 作者单位：Joon-Ho Lee MD, PhD (1)
  Sung-Hwan Cho MD (1)
  Sang-Hyun Kim MD, PhD (1)
  Won-Soek Chae MD, PhD (1)
  Hee-Cheol Jin MD, PhD (1)
  Jeong-Seok Lee MD, PhD (1)
  Yong-Ik Kim MD, PhD (1)
  
  1. Department of Anesthesiology and Pain Medicine, Bucheon Hospital, University of Soonchunhyang, 1174 Jung-Dong, Wonmi-Gu, Bucheon-Si, Gyeonggi-Do, 420-767, Korea
  

文摘

Purpose Interscalene brachial plexus block (interscalene block) complications usually depend on the dose administered. The objective of this study was to determine whether ultrasound-guided interscalene block with a 5-mL dose of 0.75% ropivacaine would have sufficient analgesic efficacy after shoulder arthroscopic surgery when compared with a 10-mL dose. Methods Patients undergoing arthroscopic rotator cuff repair surgery (n?=?60) were assigned randomly to one of two groups receiving 5?mL (Group 5) or 10?mL (Group 10) of 0.75% ropivacaine. Ultrasound-guided interscalene block was performed using the in-plane technique, and general anesthesia was administered. Time to first analgesic request was recorded, and the following issues were assessed in the postanesthesia care unit at six, 12, 24, and 48 hr postoperatively: postoperative pain as determined by a visual analogue scale (VAS), patient satisfaction, hemidiaphragmatic paralysis, other block-related complications, and postoperative nausea and vomiting (PONV). Results There was no significant difference between groups in time to first analgesic requirement (median [interquartile range] for Group 5: 16 [12-48] hr, Group 10: 18 [12-48] hr; P?=?0.907). The postoperative pain VAS score was similar in both groups. The incidence of hemidiaphragmatic paralysis on postoperative chest x-ray was 33% in Group 5 and 60% in Group 10 (P?=?0.035). However, the incidences of other block-related complications, PONV, and patient satisfaction were not significantly different between groups. Conclusion Interscalene block performed under ultrasound guidance with 0.75% ropivacaine 5?mL showed analgesic efficacy similar to that with 0.75% ropivacaine 10?mL, but with a lower incidence of hemidiaphragmatic paralysis.