Coşarcan Sami Kaan, Gurkan Yavuz, Doğan Alper Tunga, Koyuncu Özgür, Erçelen Ömür
Anesthesiology, VKV American Hospital, Istanbul, TUR.
Anesthesiology, Koç University, İstanbul, TUR.
Cureus. 2021 Jul 31;13(7):e16773. doi: 10.7759/cureus.16773. eCollection 2021 Jul.
Introduction Arthroscopic shoulder surgeries are usually performed in a sitting position. The sitting position is known to cause physiological changes related to cardiovascular adaptation. Interscalene nerve blocks (ISB) are the most commonly used techniques and are considered gold standard regional anesthesia methods for shoulder surgeries. Cerebral vessels located around sympathetic ganglia provide sympathetic system integrity. This local anesthetic spreading during ISB could be a side effect or provide a protective effect on cerebral ischemia. Our study aimed to investigate the cerebral protective effect of the ISB in arthroscopic shoulder surgeries in a sitting position. Material and methods After the approval of Koç University Clinical Research Ethics Committee (2020.020.IRB1.011), records of patients between January and December 2019 with shoulder arthroscopy at the Vehbi Koç Foundation (VKV) American hospital were retrospectively reviewed. Records of the hemodynamic response, INVOS (Medtronic, Minneapolis, USA) (rSO2) parameters, pain scores, and additional analgesic needs of all cases were examined in the intraoperative and postoperative period. Results Data of 40 patients who met the criteria to be included in the study was analyzed. Our study showed that the sitting position leading to hypotension coincided with a decrease in INVOS values. Nevertheless, we did not record any significant hypotension after ISB, and this may be due to the use of a minimal dose of local anesthetic. There was a certain increase in near-infrared spectroscopy (NIRS) values after ISB. We saw that the value of regional oxygen saturation (rSO2) increased on both the ISB side and the non-ISB side. This shows that the ISB can have a global impact on the brain. Specificially, the increase in rSO2 values in the ISB side compared to the other side suggests that ISB has possible positive effects on cerebral blood flow. Conclusion Our study has shown that ISB may transiently increase the rSO2 levels in the sitting position during shoulder surgery.
引言
肩关节镜手术通常在坐位下进行。已知坐位会引起与心血管适应相关的生理变化。肌间沟神经阻滞（ISB）是最常用的技术，被认为是肩部手术的金标准区域麻醉方法。位于交感神经节周围的脑血管提供交感神经系统的完整性。ISB期间这种局部麻醉药的扩散可能是一种副作用，也可能对脑缺血起到保护作用。我们的研究旨在探讨ISB在坐位肩关节镜手术中的脑保护作用。
材料与方法
在获得科克大学临床研究伦理委员会（2020.020.IRB1.011）批准后，对2019年1月至12月在Vehbi Koç基金会（VKV）美国医院接受肩关节镜检查的患者记录进行了回顾性分析。检查了所有病例在术中和术后的血流动力学反应、INVOS（美敦力，美国明尼阿波利斯）（rSO2）参数、疼痛评分和额外的镇痛需求记录。
结果
对40例符合纳入研究标准的患者数据进行了分析。我们的研究表明，导致低血压的坐位与INVOS值的降低同时出现。然而，我们在ISB后未记录到任何显著的低血压，这可能是由于使用了最小剂量的局部麻醉药。ISB后近红外光谱（NIRS）值有一定升高。我们发现，ISB侧和非ISB侧的局部氧饱和度（rSO2）值均升高。这表明ISB可对大脑产生全局性影响。具体而言，与另一侧相比，ISB侧rSO2值的升高表明ISB对脑血流可能有积极作用。
结论
我们的研究表明，ISB可能在肩部手术坐位期间短暂提高rSO2水平。
