2012, Number 6
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Acta Ortop Mex 2012; 26 (6)
Total shoulder arthroplasty with interscalene block. Feasibility study
Mejía-Terrazas GE, Ruiz-Suárez M, Encalada-Díaz IM, Gaspar-Carrillo SP, Valero-González F, Peña-Riveron AA
Language: Spanish
References: 24
Page: 358-361
PDF size: 58.18 Kb.
ABSTRACT
Introduction: General anesthesia is considered as the technique of choice for shoulder surgery, either alone or combined. We propose to show the feasibility of using guided interscalene block as the single anesthetic technique for total shoulder arthroplasty.
Material and methods: Neurostimulation-guided interscalene block plus sedation with dexmedetomidine were used. The following were measured intraoperatively: latency time, intraoperative analgesia, motor block according to Monzo’s scale, success rate, adverse events and complications. The following were measured postoperatively: duration of postoperative analgesia and pain intensity with a visual analogue scale at 6, 12 and 24 hours. Patient satisfaction was also measured.
Results: Intraoperative analgesia was appropriate in 100% of patients. Motor block was grade 0 in 76.4% and grade 1 in 23.6%, which is appropriate for surgery. The success rate was 100%. Mean postoperative pain at 6 hours was 0.13 ± 0.54 points in the visual analogue scale; 1.67 ± 1.15 at 12 hours, and 3.15 ± 1.66 points at 24 hours. 54.5% of patients were very satisfied and 45.5% were satisfied. Complications occurred in 18.18%.
Conclusion: This type of surgery is feasible with interscalene block plus sedation; it is a safe and efficacious technique.
REFERENCES
Goebel S, Stehle J, Schwemmer U, Reppenhagen S, Rath B, Gohlke F: Interscalene brachial plexus block for open-shoulder surgery: a randomized, double-blind, placebo-controlled trial between single-shot anesthesia and patient-controlled catheter system. Arch Orthop Trauma Surg 2010: 130: 533-40
Fredrickson M, Stewart A: Continuous interscalene analgesia for rotator cuff repair: a retrospective comparison of effectiveness and cost in 205 patients from a multiprovider private practice setting. Anaesthesia and Intensive Care 2008; 36: 786-91.
Hadzic A, Williams B, Karaca P, et al: For outpatient rotator cuff surgery, nerve block anesthesia provides superior same-day recovery over general anesthesia. Anesthesiology 2005; 102: 1001-7.
Boezaart AP: Patient-controlled interscalene analgesia after shoulder surgery: catheter insertion by the posterior approach. Anesth Analg 2006; 102: 1902.
Boezaart AP: Continuous interscalene block for ambulatory shoulder surgery. Best Practice & Research. Clinical Anesthesiology 2002; 16: 295-310.
León A, Moreno E, Ramírez M: Bloqueo interescalénico para cirugía de hombro. Rev Chilena Anest 2003: 32: 2-7.
Monzo E, Baeza C, Galindo F, Hajro M, Gonzalez A, Kim-Darov V: Bloqueo Paraescaleno del plexo braquial. Nuestra experiencia en 10 años. Rev Esp Anestesiol Reanim 2004: 51: 61-9.
Fisher G, Torrillo T, Weiner M, Rosenblatt M: The use of cerebral oximetry as a monitor of the adequacy of cerebral perfusion in a patient undergoing shoulder surgery in the beach chair position. Pain Practice 2009: 9: 304-7.
Thomas W: Shoulder replacement in a patient with severe aortic stenosis and heart failure under interscalene brachial plexus block. Reg Anesth Pain Med 2007: 06: 275.
Brown A, Weiss R, Greenberg E: Interescaleno block for shoulder arthroscopy comparison with general anesthesia. Arthroscopy 1993: 9: 295-300.
Russon K, Sardesai M, Ridgway S, Whitear J, Sildown J, et al: Postoperative shoulder surgery an internum report of major shoulder surgery as a day case procedure. Br J Anaesth 2006: 6: 69-73.
Bishop J, Sprague M, Gelber J: Interescalenic regional anesthesia for shoulder surgery. J Bone Joint Surg Am 2005: 87: 974-9.
Fredrickson M, Krishnan S, Chen C: Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques. Anaesthesia 2010: 65: 608-24.
Skyhar M, Altchek D, Warren R: Shoulder arthroscopy with the patient in the beach chair position. J Arthroscopy 1988: 4: 256-60.
Winnie A: Interscalene brachial plexus block. Anesth Analg 1970; 49: 455-66.
Zaragoza G, Mejía G, Sánchez B, Gaspar S: Escala de la respuesta motora a la neuroestimulación. Reporte técnico. Rev Mex Anest 2006; 29 (4): 221-5.
Tsui B, Wagner A, Finucane A: Electrophysiologic effect of injectates on peripheral nerve stimulation. Reg Anesth Pain Med 2004; 29: 189-93.
Nemethy M, Paroli L, Williams P, Blanck T: Assessing Sedation with Regional Anesthesia: Inter-Rater Agreement on a Modified Wilson Sedation Scale. Anesth Analg 2002; 94: 723-8.
Bhatti T, Sivasubramaniam T: Low level, low volume interscalene block for shoulder surgery in patients with chronic obstructive pulmonary disease. Reg Anest Pain Med 2008: 7: 152.
Thomas W: Shoulder replacement in a patient with severe aortic stenosis and heart failure under interscalene brachial plexus block. Reg Anest Pain Med 2007: 6: 275.
Casati A, Vinciguera F, Scarioni M, Cappelleri G, Aldequeri G, Manzoni P, Fraschini G, Chellly J: Lidocaine vs ropivacaine for continuous interescalenic brachial plexus block after open shoulder surgery. Acta Anaesthesiol Scand 2003: 47: 355-60.
Candido K, Sukhani R, Doty R, Nader A, Kendall M, Yaghmour E, Kataria T, McCarthy R: Neurologic Sequelae After Interscalene Brachial Plexus Block for Shoulder/Upper Arm Surgery: The Association of Patient, Anesthetic, and Surgical Factors to the Incidence and Clinical Course. Anesth Analg 2005; 100: 1489-95.
Walton E, Folk J, Friedman R, Dorman H: Complete Brachial Plexus Palsy After Total Shoulder Arthroplasty Done With Interscalene Block Anesthesia. Reg Anesth Pain Med 2000; 25: 318-21.
Tetzlaff J, Dilger J, Yap E, Brems J: Idiopathic Brachial Plexitis After Total Shoulder Replacement with lnterscalene Brachial Plexus Block. Anesth Analg 1997; 85: 6446.