TY - JOUR T1 - Continuous interscalene versus phrenic nerve-sparing high-thoracic erector spinae plane block for total shoulder arthroplasty: a randomized controlled trial. AU - Sun,Lisa Y, AU - Basireddy,Shruthi, AU - Gerber,Lynn Ngai, AU - Lamano,Jason, AU - Costouros,John, AU - Cheung,Emilie, AU - Boublik,Jan, AU - Horn,Jean Louis, AU - Tsui,Ban C H, Y1 - 2022/03/02/ PY - 2021/07/09/received PY - 2021/12/02/accepted PY - 2021/11/16/revised PY - 2022/3/4/pubmed PY - 2022/5/7/medline PY - 2022/3/3/entrez KW - ESP KW - Erector spinae plane block KW - diaphragm KW - interscalene KW - nerve block KW - perineural catheter KW - phrenic nerve KW - total shoulder arthroplasty SP - 614 EP - 623 JF - Canadian journal of anaesthesia = Journal canadien d'anesthesie JO - Can J Anaesth VL - 69 IS - 5 N2 - PURPOSE: The high-thoracic erector spinae plane block (HT-ESPB) has been reported as an effective analgesic modality for the shoulder region without phrenic nerve palsy. The goal of this study was to compare the HT-ESPB as a phrenic nerve-sparing alternative to an interscalene block for total shoulder arthroplasty. METHODS: Thirty patients undergoing total shoulder arthroplasty at Stanford Health Care (Palo Alto, CA, USA) were enrolled in a double-blind randomized controlled trial. We randomized 28 patients to receive either an interscalene or HT-ESPB perineural catheter preoperatively; 26 patients were included in the final analysis. The study was powered for the primary outcome of incidence of hemidiaphragmatic paralysis in the postanesthesia care unit (PACU). Other outcome measures included incentive spirometry volume, brachial plexus motor and sensory exams, adverse events, pain scores, and opioid consumption. RESULTS: The incidence of hemidiaphragmatic paralysis in the HT-ESPB catheter group was significantly lower than in the interscalene catheter group (0/12, 0% vs 14/14, 100%; P < 0.001). No statistically significant differences were found in pain scores and opioid consumption (in oral morphine equivalents) between the interscalene and HT-ESPB groups through postoperative day (POD) 2. Nevertheless, the mean (standard deviation) point estimates for opioid consumption for the HT-ESPB group were higher than for the interscalene group in the PACU (HT-ESPB: 24.8 [26.7] mg; interscalene: 10.7 [21.7] mg) and for POD 0 (HT-ESPB: 20.5 [25.0] mg; interscalene: 6.7 [12.0] mg). In addition, cumulative postoperative opioid consumption was significantly higher at POD 0 (PACU through POD 0) in the HT-ESPB group (45.3 [39.9] mg) than in the interscalene group (16.6 [21.9] mg; P = 0.04). CONCLUSIONS: This study suggests that continuous HT-ESPB can be a phrenic nerve-sparing alternative to continuous interscalene brachial plexus blockade, although the latter provided superior opioid-sparing in the immediate postoperative period. This was a small sample size study, and further investigations powered to detect differences in analgesic and quality of recovery score endpoints are needed. STUDY REGISTRATION: www. CLINICALTRIALS: gov (NCT03807505); registered 17 January 2019. SN - 1496-8975 UR - https://www.unboundmedicine.com/medline/citation/35237953/Continuous_interscalene_versus_phrenic_nerve_sparing_high_thoracic_erector_spinae_plane_block_for_total_shoulder_arthroplasty:_a_randomized_controlled_trial_ DB - PRIME DP - Unbound Medicine ER -