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Differential lung ventilation assessed by electrical impedance tomography in ultrasound-guided anterior suprascapular nerve block vs. interscalene brachial plexus block: A patient and assessor-blind, randomised controlled trial.
Eur J Anaesthesiol. 2020 12; 37(12):1105-1114.EJ

Abstract

BACKGROUND

Ultrasound-guided interscalene brachial plexus block (ISB) is used to control pain after shoulder surgery. Though effective, drawbacks include phrenic nerve block and motor block of the hand. The ultrasound-guided anterior approach to perform suprascapular nerve block (SSNB) may provide a good alternative.

OBJECTIVE

To compare lung ventilation and diaphragmatic activity on the operated side in ISB and SSNB.

DESIGN

Randomised, controlled patient-blinded and assessor-blinded trial.

SETTING

Outpatient surgical clinic with recruitment from June 2017 to January 2018.

PATIENTS

Fifty-five outpatients scheduled for arthroscopic shoulder surgery were allocated randomly to receive SSNB or ISB. Technical problems with monitoring devices unrelated to the intervention led to exclusion of seven patients. The remaining 48 (n=24 in each group) were followed up for 24 h without drop-outs.

INTERVENTIONS

Patients received 10 ml of ropivacaine 1.0% wt/vol for both procedures.

OUTCOME MEASURES

Percentage lung ventilation on the operated side was the primary endpoint as assessed with electrical impedance tomography (EIT). Secondary endpoints were hemidiaphragmatic motion on the operated side, pain, opioid use, hand strength and numbness, and patient satisfaction.

RESULTS

Before regional anaesthesia, the lung on the operated side contributed a median [IQR] of 50 [42 to 56]% of the total lung ventilation. Postoperatively, it was 40 [3 to 50]% (SSNB) vs. 3 [1 to 13]% (ISB) for an adjusted difference of 23 (95% CI, 13 to 34)%, (P < 0.001). Hemidiaphragmatic motion was 1.90 (95% CI, 1.37 to 2.44 cm), (P < 0.001) lower in the ISB group compared with the SSNB group. Hand strength was 11.2 (95% CI 3.6 to 18.9), (P = 0.0024) kg greater for SSNB and numbness was observed in 0% (SSNB) vs. 46% (ISB) of patients, P < 0.001. Pain was low in the first 6 h after surgery in both groups with slightly, but not significantly, lower values for ISB. No meaningful or significant differences were found for opioid use or patient satisfaction.

CONCLUSION

An ultrasound-guided anterior approach to SSNB preserves ipsilateral lung ventilation and phrenic function better than a standard ISB.

TRIAL REGISTRATION

drks.de identifier: DRKS00011787.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Petroff D
From the Clinical Trial Centre, University of Leipzig (DP), ACQUA Clinic, Department of Anaesthesiology (MW, VP), Innovation Center Computer Assisted Surgery, University of Leipzig, Leipzig (PS, JM) and Department of Anaesthesiology and Intensive Care and Pain Medicine, Heinrich Braun Hospital Zwickau, Zwickau, Germany (AWR).
Wiegel M
No affiliation info available
Pech V
No affiliation info available
Salz P
No affiliation info available
Mrongowius J
No affiliation info available
Reske AW
No affiliation info available

MeSH

Anesthetics, LocalArthroscopyBrachial Plexus BlockElectric ImpedanceHumansLungPain, PostoperativeShoulderTomographyUltrasonography, Interventional

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

33105246

Citation

Petroff, David, et al. "Differential Lung Ventilation Assessed By Electrical Impedance Tomography in Ultrasound-guided Anterior Suprascapular Nerve Block Vs. Interscalene Brachial Plexus Block: a Patient and Assessor-blind, Randomised Controlled Trial." European Journal of Anaesthesiology, vol. 37, no. 12, 2020, pp. 1105-1114.
Petroff D, Wiegel M, Pech V, et al. Differential lung ventilation assessed by electrical impedance tomography in ultrasound-guided anterior suprascapular nerve block vs. interscalene brachial plexus block: A patient and assessor-blind, randomised controlled trial. Eur J Anaesthesiol. 2020;37(12):1105-1114.
Petroff, D., Wiegel, M., Pech, V., Salz, P., Mrongowius, J., & Reske, A. W. (2020). Differential lung ventilation assessed by electrical impedance tomography in ultrasound-guided anterior suprascapular nerve block vs. interscalene brachial plexus block: A patient and assessor-blind, randomised controlled trial. European Journal of Anaesthesiology, 37(12), 1105-1114. https://doi.org/10.1097/EJA.0000000000001367
Petroff D, et al. Differential Lung Ventilation Assessed By Electrical Impedance Tomography in Ultrasound-guided Anterior Suprascapular Nerve Block Vs. Interscalene Brachial Plexus Block: a Patient and Assessor-blind, Randomised Controlled Trial. Eur J Anaesthesiol. 2020;37(12):1105-1114. PubMed PMID: 33105246.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differential lung ventilation assessed by electrical impedance tomography in ultrasound-guided anterior suprascapular nerve block vs. interscalene brachial plexus block: A patient and assessor-blind, randomised controlled trial. AU - Petroff,David, AU - Wiegel,Martin, AU - Pech,Virginia, AU - Salz,Peter, AU - Mrongowius,Julia, AU - Reske,Andreas W, PY - 2020/10/27/pubmed PY - 2021/4/28/medline PY - 2020/10/26/entrez SP - 1105 EP - 1114 JF - European journal of anaesthesiology JO - Eur J Anaesthesiol VL - 37 IS - 12 N2 - BACKGROUND: Ultrasound-guided interscalene brachial plexus block (ISB) is used to control pain after shoulder surgery. Though effective, drawbacks include phrenic nerve block and motor block of the hand. The ultrasound-guided anterior approach to perform suprascapular nerve block (SSNB) may provide a good alternative. OBJECTIVE: To compare lung ventilation and diaphragmatic activity on the operated side in ISB and SSNB. DESIGN: Randomised, controlled patient-blinded and assessor-blinded trial. SETTING: Outpatient surgical clinic with recruitment from June 2017 to January 2018. PATIENTS: Fifty-five outpatients scheduled for arthroscopic shoulder surgery were allocated randomly to receive SSNB or ISB. Technical problems with monitoring devices unrelated to the intervention led to exclusion of seven patients. The remaining 48 (n=24 in each group) were followed up for 24 h without drop-outs. INTERVENTIONS: Patients received 10 ml of ropivacaine 1.0% wt/vol for both procedures. OUTCOME MEASURES: Percentage lung ventilation on the operated side was the primary endpoint as assessed with electrical impedance tomography (EIT). Secondary endpoints were hemidiaphragmatic motion on the operated side, pain, opioid use, hand strength and numbness, and patient satisfaction. RESULTS: Before regional anaesthesia, the lung on the operated side contributed a median [IQR] of 50 [42 to 56]% of the total lung ventilation. Postoperatively, it was 40 [3 to 50]% (SSNB) vs. 3 [1 to 13]% (ISB) for an adjusted difference of 23 (95% CI, 13 to 34)%, (P < 0.001). Hemidiaphragmatic motion was 1.90 (95% CI, 1.37 to 2.44 cm), (P < 0.001) lower in the ISB group compared with the SSNB group. Hand strength was 11.2 (95% CI 3.6 to 18.9), (P = 0.0024) kg greater for SSNB and numbness was observed in 0% (SSNB) vs. 46% (ISB) of patients, P < 0.001. Pain was low in the first 6 h after surgery in both groups with slightly, but not significantly, lower values for ISB. No meaningful or significant differences were found for opioid use or patient satisfaction. CONCLUSION: An ultrasound-guided anterior approach to SSNB preserves ipsilateral lung ventilation and phrenic function better than a standard ISB. TRIAL REGISTRATION: drks.de identifier: DRKS00011787. SN - 1365-2346 UR - https://www.unboundmedicine.com/medline/citation/33105246/Differential_lung_ventilation_assessed_by_electrical_impedance_tomography_in_ultrasound_guided_anterior_suprascapular_nerve_block_vs__interscalene_brachial_plexus_block:_A_patient_and_assessor_blind_randomised_controlled_trial_ DB - PRIME DP - Unbound Medicine ER -
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