Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA.
Reg Anesth Pain Med. 2023 Nov;48(11):540-546. doi: 10.1136/rapm-2022-104264. Epub 2023 May 12.
Continuous interscalene nerve block techniques are an effective form of targeted non-opioid postoperative analgesia for shoulder arthroplasty patients. One of the limiting risks, however, is potential phrenic nerve blockade with resulting hemidiaphragmatic paresis and respiratory compromise. While studies have focused on block-related technical aspects to limit the incidence of phrenic nerve palsy, little is known about other factors associated with increased risk of clinical respiratory complications in this population.
A single-institution retrospective cohort study was conducted using electronic health records from adult patients who underwent elective shoulder arthroplasty with continuous interscalene brachial plexus blocks (CISB). Data collected included patient, nerve block, and surgery characteristics. Respiratory complications were categorized into four groups (none, mild, moderate, and severe). Univariate and multivariable analyses were conducted.
Among 1025 adult shoulder arthroplasty cases, 351 (34%) experienced any respiratory complication. These 351 were subdivided into 279 (27%) mild, 61 (6%) moderate, and 11 (1%) severe respiratory complications. In an adjusted analysis, patient-related factors were associated with an increased likelihood of respiratory complication: ASA Physical Status III (OR 1.69, 95% CI 1.21 to 2.36); asthma (OR 1.59, 95% CI 1.07 to 2.37); congestive heart failure (OR 1.99, 95% CI 1.19 to 3.33); body mass index (OR 1.06, 95% CI 1.03 to 1.09); age (OR 1.02, 95% CI 1.00 to 1.04); and preoperative oxygen saturation (SpO2). For every 1% decrease in preoperative SpO2, there was an associated 32% higher likelihood of a respiratory complication (OR 1.32, 95% CI 1.20 to 1.46, p<0.001).
Patient-related factors that can be measured preoperatively are associated with increased likelihood of respiratory complications after elective shoulder arthroplasty with CISB.
连续锁骨下神经阻滞技术是肩部关节置换术后患者靶向非阿片类术后镇痛的有效形式。然而，其中一个限制风险是潜在的膈神经阻滞，导致膈肌麻痹和呼吸功能受损。虽然研究集中在与阻滞相关的技术方面，以限制膈神经麻痹的发生率，但对于该人群中与临床呼吸并发症风险增加相关的其他因素知之甚少。
对接受连续锁骨下臂丛神经阻滞（CISB）的择期肩部关节置换术成年患者的电子健康记录进行单机构回顾性队列研究。收集的数据包括患者、神经阻滞和手术特征。将呼吸并发症分为四组（无、轻度、中度和重度）。进行了单变量和多变量分析。
在 1025 例成人肩部关节置换术病例中，有 351 例（34%）出现任何呼吸并发症。这 351 例分为 279 例（27%）轻度、61 例（6%）中度和 11 例（1%）重度呼吸并发症。在调整分析中，与患者相关的因素与呼吸并发症的发生几率增加相关：ASA 身体状况 III 级（OR 1.69，95%CI 1.21 至 2.36）；哮喘（OR 1.59，95%CI 1.07 至 2.37）；充血性心力衰竭（OR 1.99，95%CI 1.19 至 3.33）；体重指数（OR 1.06，95%CI 1.03 至 1.09）；年龄（OR 1.02，95%CI 1.00 至 1.04）；和术前血氧饱和度（SpO2）。术前 SpO2 每降低 1%，呼吸并发症的发生几率就会增加 32%（OR 1.32，95%CI 1.20 至 1.46，p<0.001）。
术前可测量的患者相关因素与 CISB 后择期肩部关节置换术后呼吸并发症的发生几率增加相关。
