Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Health System, Mankato, MN, USA.
BMC Anesthesiol. 2021 Jul 9;21(1):187. doi: 10.1186/s12871-021-01409-3.
Fluid extravasation from the shoulder compartment and subsequent absorption into adjacent soft tissue is a well-documented phenomenon in arthroscopic shoulder surgery. We aimed to determine if a qualitative difference in ultrasound imaging of the interscalene brachial plexus exists in relation to the timing of performing an interscalene nerve block (preoperative or postoperative).
This single-center, prospective observational study compared pre- and postoperative interscalene brachial plexus ultrasound images of 29 patients undergoing shoulder arthroscopy using a pretest-posttest methodology where individual patients served as their own controls. Three fellowship-trained regional anesthesiologists evaluated image quality and confidence in performing a block for each ultrasound scan using a five-point Likert scale. The association of image quality with age, gender, BMI, duration of surgery, obstructive sleep apnea, and volume of arthroscopic irrigation fluid were analyzed as secondary outcomes.
Aggregate preoperative mean scores in quality of ultrasound visualization were higher than postoperative scores (preoperative 4.5 vs postoperative 3.8; p < .001), as was confidence in performing blockade based upon the imaging (preoperative 4.8 vs postoperative 4.2; p < .001). Larger BMI negatively affected visualization of the brachial plexus in the preoperative period (p < 0.05 for both weight categories). Patients with intermediate-high risk or confirmed obstructive sleep apnea had lower aggregate postoperative mean scores compared to the low-risk group for both ultrasound visualization (3.4 vs 4.0; p < .05) and confidence in block performance (3.8 vs 4.4; p < .05).
Due to the potential reduction of ultrasound visualization of the interscalene brachial plexus after shoulder arthroscopy, we advocate for a preoperative interscalene nerve block when feasible.
ClinicalTrials.gov ( NCT03657173 ; September 4, 2018).
在关节镜肩关节手术中，液体从肩部间隙渗出并随后被吸收到相邻的软组织中是一种有充分文献记录的现象。我们旨在确定在进行肌间沟臂丛神经阻滞时（术前或术后），肌间沟臂丛神经的超声成像是否存在定性差异。
这项单中心、前瞻性观察性研究比较了 29 例接受肩关节镜手术患者的术前和术后肌间沟臂丛神经超声图像，采用预测试-后测试方法，每位患者作为自己的对照。三位接受过 fellowship培训的区域麻醉医师使用五点 Likert 量表评估每位患者的超声扫描图像质量和进行阻滞的信心。分析图像质量与年龄、性别、BMI、手术持续时间、阻塞性睡眠呼吸暂停和关节镜灌洗液量的关系作为次要结局。
术前平均超声可视化质量评分高于术后评分（术前 4.5 分 vs 术后 3.8 分；p < 0.001），基于影像学进行阻滞的信心也是如此（术前 4.8 分 vs 术后 4.2 分；p < 0.001）。更大的 BMI 会在术前阶段对臂丛神经的可视化产生负面影响（两个体重类别均为 p < 0.05）。中高危或确诊阻塞性睡眠呼吸暂停的患者与低危组相比，术后平均超声可视化评分（3.4 分 vs 4.0 分；p < 0.05）和阻滞信心评分（3.8 分 vs 4.4 分；p < 0.05）均较低。
由于肩关节镜手术后臂丛神经的超声可视化可能会降低，因此我们主张在可行的情况下进行术前肌间沟神经阻滞。
ClinicalTrials.gov（NCT03657173；2018 年 9 月 4 日）。
