Tags

Type your tag names separated by a space and hit enter

Prospective, Randomized Double-Blind Study: Does Decreasing Interscalene Nerve Block Volume for Surgical Anesthesia in Ambulatory Shoulder Surgery Offer Same-Day Patient Recovery Advantages?
Reg Anesth Pain Med. 2016 Jul-Aug; 41(4):438-44.RA

Abstract

BACKGROUND AND OBJECTIVES

In this randomized double-blind prospective study in patients undergoing shoulder arthroscopy, we compared the effects of ultrasound-guided interscalene nerve block using 20 mL (intervention group) and 40 mL (control group) of a mepivacaine 1.5% and bupivacaine 0.5% mixture (1:1 volume) on ipsilateral handgrip strength and other postoperative end points.

METHODS

One hundred fifty-four patients scheduled for ambulatory shoulder arthroscopy were randomly assigned to receive a single-injection interscalene block under ultrasound guidance with either 40 mL (control) or 20 mL (intervention) and intravenous sedation. The primary outcome was the change in ipsilateral handgrip strength in the postanesthesia care unit (PACU) measured with a dynamometer. Secondary end points were recorded, including negative inspiratory force, incidences of hoarseness and Horner syndrome, time to readiness for discharge from PACU, time to discharge from PACU, patient satisfaction, time to block resolution, and pain scores.

RESULTS

Postoperative handgrip strength was greater in the 20-mL group compared with the 40-mL group (difference in means, 2.3 kg [95% confidence interval, 0.6-4.0 kg]; P = 0.009). A smaller proportion of patients in the intervention group experienced hoarseness postoperatively compared with the control group (odds ratio, 0.26 [95% confidence interval, 0.08-0.82]; P = 0.015). Patient satisfaction and duration of analgesia were similar in both groups.

CONCLUSIONS

When used for surgical anesthesia for shoulder arthroscopies in the ambulatory setting, a 20-mL volume in an ultrasound-guided interscalene block preserves greater handgrip strength on the ipsilateral side in the PACU compared with 40 mL without significant decrease in block success, duration of analgesia, and patient satisfaction.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Maalouf DB
From the *Department of Anesthesiology, Hospital for Special Surgery; †Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Medical Center; and ‡Department of Biostatistics, Hospital for Special Surgery, New York, NY; ¶Private practice.
Dorman SM
No affiliation info available
Sebeo J
No affiliation info available
Goytizolo EA
No affiliation info available
Gordon MA
No affiliation info available
Yadeau JT
No affiliation info available
Dehipawala SS
No affiliation info available
Fields K
No affiliation info available

MeSH

AdultAgedAmbulatory Surgical ProceduresAnesthesia Recovery PeriodAnesthetics, CombinedAnesthetics, LocalArthroscopyBupivacaineDouble-Blind MethodFemaleHand StrengthHumansLength of StayMaleMepivacaineMiddle AgedMuscle Strength DynamometerNerve BlockNew York CityPain MeasurementPain, PostoperativePatient DischargePatient SatisfactionProspective StudiesRecovery of FunctionShoulderSurveys and QuestionnairesTime FactorsTreatment OutcomeUltrasonography, Interventional

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27281727

Citation

Maalouf, Daniel B., et al. "Prospective, Randomized Double-Blind Study: Does Decreasing Interscalene Nerve Block Volume for Surgical Anesthesia in Ambulatory Shoulder Surgery Offer Same-Day Patient Recovery Advantages?" Regional Anesthesia and Pain Medicine, vol. 41, no. 4, 2016, pp. 438-44.
Maalouf DB, Dorman SM, Sebeo J, et al. Prospective, Randomized Double-Blind Study: Does Decreasing Interscalene Nerve Block Volume for Surgical Anesthesia in Ambulatory Shoulder Surgery Offer Same-Day Patient Recovery Advantages? Reg Anesth Pain Med. 2016;41(4):438-44.
Maalouf, D. B., Dorman, S. M., Sebeo, J., Goytizolo, E. A., Gordon, M. A., Yadeau, J. T., Dehipawala, S. S., & Fields, K. (2016). Prospective, Randomized Double-Blind Study: Does Decreasing Interscalene Nerve Block Volume for Surgical Anesthesia in Ambulatory Shoulder Surgery Offer Same-Day Patient Recovery Advantages? Regional Anesthesia and Pain Medicine, 41(4), 438-44. https://doi.org/10.1097/AAP.0000000000000418
Maalouf DB, et al. Prospective, Randomized Double-Blind Study: Does Decreasing Interscalene Nerve Block Volume for Surgical Anesthesia in Ambulatory Shoulder Surgery Offer Same-Day Patient Recovery Advantages. Reg Anesth Pain Med. 2016 Jul-Aug;41(4):438-44. PubMed PMID: 27281727.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective, Randomized Double-Blind Study: Does Decreasing Interscalene Nerve Block Volume for Surgical Anesthesia in Ambulatory Shoulder Surgery Offer Same-Day Patient Recovery Advantages? AU - Maalouf,Daniel B, AU - Dorman,Shawna M, AU - Sebeo,Joseph, AU - Goytizolo,Enrique A, AU - Gordon,Michael A, AU - Yadeau,Jacques T, AU - Dehipawala,Sumudu S, AU - Fields,Kara, PY - 2016/6/10/entrez PY - 2016/6/10/pubmed PY - 2017/3/14/medline SP - 438 EP - 44 JF - Regional anesthesia and pain medicine JO - Reg Anesth Pain Med VL - 41 IS - 4 N2 - BACKGROUND AND OBJECTIVES: In this randomized double-blind prospective study in patients undergoing shoulder arthroscopy, we compared the effects of ultrasound-guided interscalene nerve block using 20 mL (intervention group) and 40 mL (control group) of a mepivacaine 1.5% and bupivacaine 0.5% mixture (1:1 volume) on ipsilateral handgrip strength and other postoperative end points. METHODS: One hundred fifty-four patients scheduled for ambulatory shoulder arthroscopy were randomly assigned to receive a single-injection interscalene block under ultrasound guidance with either 40 mL (control) or 20 mL (intervention) and intravenous sedation. The primary outcome was the change in ipsilateral handgrip strength in the postanesthesia care unit (PACU) measured with a dynamometer. Secondary end points were recorded, including negative inspiratory force, incidences of hoarseness and Horner syndrome, time to readiness for discharge from PACU, time to discharge from PACU, patient satisfaction, time to block resolution, and pain scores. RESULTS: Postoperative handgrip strength was greater in the 20-mL group compared with the 40-mL group (difference in means, 2.3 kg [95% confidence interval, 0.6-4.0 kg]; P = 0.009). A smaller proportion of patients in the intervention group experienced hoarseness postoperatively compared with the control group (odds ratio, 0.26 [95% confidence interval, 0.08-0.82]; P = 0.015). Patient satisfaction and duration of analgesia were similar in both groups. CONCLUSIONS: When used for surgical anesthesia for shoulder arthroscopies in the ambulatory setting, a 20-mL volume in an ultrasound-guided interscalene block preserves greater handgrip strength on the ipsilateral side in the PACU compared with 40 mL without significant decrease in block success, duration of analgesia, and patient satisfaction. SN - 1532-8651 UR - https://www.unboundmedicine.com/medline/citation/27281727/Prospective_Randomized_Double_Blind_Study:_Does_Decreasing_Interscalene_Nerve_Block_Volume_for_Surgical_Anesthesia_in_Ambulatory_Shoulder_Surgery_Offer_Same_Day_Patient_Recovery_Advantages DB - PRIME DP - Unbound Medicine ER -