Coşarcan Sami Kaan, Doğan Alper T, Koyuncu Özgür, Gurkan Yavuz, Erçelen Ömür
Anesthesiology, Vehbi Koç Foundation (VKV) American Hospital, Istanbul, TUR.
Orthopaedics and Traumatology, Vehbi Koç Foundation (VKV) American Hospital, Istanbul, TUR.
Cureus. 2022 Nov 10;14(11):e31350. doi: 10.7759/cureus.31350. eCollection 2022 Nov.
Objective The interscalene brachial plexus block (ISBB) constitutes the gold standard for analgesia after shoulder procedures. Ipsilateral phrenic nerve block remains the most common adverse effect after ISBB. Alternative nerve blocks are performed in shoulder surgery in order to prevent hemi-diaphragmatic paralysis (HDP). The purpose of the present study was to investigate the minimum effective local anesthetic volume of 0.5% bupivacaine for postoperative analgesia with an anterior suprascapular nerve block (ASSB). The secondary aim was to investigate diaphragm functions with the local anesthetic doses used while conducting effective volume research. Method This prospective observational study was conducted at the American Hospital of Istanbul, Turkey, from March to July 2022. The initial injected volume of 0.5% bupivacaine was 10 ml. Our clinical experience indicates that this yields a complete sensory block of the anterior suprascapular nerve. In accordance with the up-and-down method, the volume of 0.5% bupivacaine used for a particular patient was determined by the outcome of the preceding block, which represented block success. In case of effective ASSB being achieved, the volume of 0.5% bupivacaine to be administered to the next patient was lowered by 1 ml. In case of block failure, however, the volume of 0.5% bupivacaine to be applied in the subsequent case was increased by 1 ml. Ipsilateral hemi-diaphragmatic movement measurements were taken before (baseline) and 30 minutes after the block. General anesthesia was induced 60 minutes after the completion of the block performance by means of a standardized protocol. Results Sixty-seven patients were included in the study. The ED50 and ED95 calculated for anterior suprascapular nerve block using probit transformation and logistic regression analysis were 2.646 (95% CI, 0.877-2.890) and 3.043 ml (95% CI, 2.771-4.065), respectively. When complete paralysis was defined as 75% or above, partial paralysis as 25-50%, and no paralysis as 25% or less, volumes of 6 ml or lower appeared to cause no paralysis for the anterior suprascapular nerve block. Conclusion We, therefore, recommend using a volume of 6 ml or less in order to achieve diaphragm-sparing features for anterior suprascapular nerve blocks.
目的 肌间沟臂丛神经阻滞（ISBB）是肩部手术后镇痛的金标准。同侧膈神经阻滞仍是ISBB后最常见的不良反应。在肩部手术中采用替代神经阻滞以预防半膈肌麻痹（HDP）。本研究的目的是探讨0.5%布比卡因用于肩胛上神经前支阻滞（ASSB）术后镇痛的最小有效局麻药量。次要目的是在进行有效药量研究时，观察所用局麻剂量下的膈肌功能。方法 本前瞻性观察性研究于2022年3月至7月在土耳其伊斯坦布尔美国医院进行。0.5%布比卡因的初始注射量为10 ml。我们的临床经验表明，这可产生肩胛上神经前支的完全感觉阻滞。根据上下法，特定患者所用0.5%布比卡因的量由前一次阻滞的结果决定，前一次阻滞代表阻滞成功。若实现有效ASSB，下一位患者给予的0.5%布比卡因量减少1 ml。然而，若阻滞失败，后续病例应用的0.5%布比卡因量增加1 ml。在阻滞前（基线）和阻滞后30分钟进行同侧半膈肌运动测量。在完成阻滞操作60分钟后，通过标准化方案诱导全身麻醉。结果 67例患者纳入研究。采用概率转换和逻辑回归分析计算的肩胛上神经前支阻滞的ED50和ED95分别为2.646（95%CI，0.877 - 2.890）和3.043 ml（95%CI，2.771 - 4.065）。当将完全麻痹定义为75%及以上、部分麻痹定义为25% - 50%、无麻痹定义为25%及以下时，6 ml及以下的药量似乎不会导致肩胛上神经前支阻滞出现麻痹。结论因此，我们建议使用6 ml及以下的药量，以实现肩胛上神经前支阻滞的膈肌保留特性。
