Reduced hemidiaphragmatic paresis with extrafascial compared with conventional intrafascial tip placement for continuous interscalene brachial plexus block: a randomized, controlled, double-blind trial.

Details

Serval ID
serval:BIB_5F1144D88880
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Reduced hemidiaphragmatic paresis with extrafascial compared with conventional intrafascial tip placement for continuous interscalene brachial plexus block: a randomized, controlled, double-blind trial.
Journal
British journal of anaesthesia
Author(s)
Albrecht E., Bathory I., Fournier N., Jacot-Guillarmod A., Farron A., Brull R.
ISSN
1471-6771 (Electronic)
ISSN-L
0007-0912
Publication state
Published
Issued date
01/04/2017
Peer-reviewed
Oui
Volume
118
Number
4
Pages
586-592
Language
english
Notes
Publication types: Comparative Study ; Journal Article ; Randomized Controlled Trial
Publication Status: ppublish
Abstract
The incidence of hemidiaphragmatic paresis with continuous interscalene brachial plexus block (CISB) can approach 100%. We tested the hypothesis that extrafascial placement of the catheter tip reduces the rate of hemidiaphragmatic paresis compared with intrafascial tip placement for CISB while providing effective analgesia.
Seventy patients undergoing elective major shoulder surgery under general anaesthesia were randomized to receive an ultrasound-guided CISB plexus block for analgesia with the catheter tip placed either within (intrafascial group) or immediately outside (extrafascial group) the brachial plexus sheath midway between the levels of C5 and C6. Catheters were bolus dosed with ropivacaine 0.5% 20 ml before surgery, followed by an infusion of ropivacaine 0.2% at 4 ml h -1 for the first 2 days after surgery. The primary outcome was hemidiaphragmatic paresis measured by M-mode ultrasonography on postoperative day (POD) 1. Secondary outcomes included forced vital capacity, forced expiratory volume in 1 s, and rest pain scores.
The incidence of hemidiaphragmatic paresis on POD 1 was significantly reduced in the extrafascial group {intrafascial, 41% [95% confidence interval (CI) 25-59%]; extrafascial, 15% (95% CI 5-32%); P =0.01}. We were unable to detect a difference between groups in any of the functional respiratory outcomes or in rest pain scores [numerical rating scale (1-10): intrafascial, 3 (95% CI 2-3); extrafascial, 3 (95% CI: 2-4); P =0.93] on POD 1.
Placement of the catheter tip immediately outside of the brachial plexus sheath reduced the incidence of hemidiaphragmatic paresis on POD 1 associated with ultrasound-guided CISB while providing effective analgesia after major shoulder surgery. Our results do not support the routine placement of the catheter tip within the brachial plexus sheath for CISB.
NCT02433561.
Keywords
Aged, Analgesia, Patient-Controlled, Anesthetics, Local/administration & dosage, Brachial Plexus/diagnostic imaging, Brachial Plexus Block/methods, Catheters, Double-Blind Method, Echocardiography, Female, Humans, Incidence, Male, Middle Aged, Pain, Postoperative/drug therapy, Pain, Postoperative/epidemiology, Postoperative Complications/chemically induced, Postoperative Complications/drug therapy, Postoperative Complications/epidemiology, Respiratory Paralysis/chemically induced, Respiratory Paralysis/epidemiology, Ropivacaine/administration & dosage, Treatment Outcome, Ultrasonography, Interventional, Analgesia, Patient-Controlled, regional anaesthesia, brachial plexus block, diaphragm
Pubmed
Web of science
Create date
20/04/2017 11:03
Last modification date
20/08/2019 15:16
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