Comparison Between Ultrasound-Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Patients Undergoing Arthroscopic Shoulder Surgery: A Prospective, Randomized, Parallel Study

Taeha Ryu, Byung Tae Kil, Jong Hae Kim, Taeha Ryu, Byung Tae Kil, Jong Hae Kim

Abstract

Although supraclavicular brachial plexus block (SCBPB) was repopularized by the introduction of ultrasound, its usefulness in shoulder surgery has not been widely reported. The objective of this study was to compare motor and sensory blockades, the incidence of side effects, and intraoperative opioid analgesic requirements between SCBPB and interscalene brachial plexus block (ISBPB) in patients undergoing arthroscopic shoulder surgery. Patients were randomly assigned to 1 of 2 groups (ISBPB group: n = 47; SCBPB group: n = 46). The side effects of the brachial plexus block (Horner's syndrome, hoarseness, and subjective dyspnea), the sensory block score (graded from 0 [no cold sensation] to 100 [intact sensation] using an alcohol swab) for each of the 5 dermatomes (C5-C8 and T1), and the motor block score (graded from 0 [complete paralysis] to 6 [normal muscle force]) for muscle forces corresponding to the radial, ulnar, median, and musculocutaneous nerves were evaluated 20 min after the brachial plexus block. Fentanyl was administered in 50 μg increments when the patients complained of pain that was not relieved by the brachial plexus block. There were no conversions to general anesthesia due to a failed brachial plexus block. The sensory block scores for the C5 to C8 dermatomes were significantly lower in the ISBPB group. However, the percentage of patients who received fentanyl was comparable between the 2 groups (27.7% [ISBPB group] and 30.4% [SCBPB group], P = 0.77). SCBPB produced significantly lower motor block scores for the radial, ulnar, and median nerves than did ISBPB. A significantly higher incidence of Horner's syndrome was observed in the ISBPB group (59.6% [ISBPB group] and 19.6% [SCBPB group], P < 0.001). No patient complained of subjective dyspnea. Despite the weaker degree of sensory blockade provided by SCBPB in comparison to ISBPB, opioid analgesic requirements are similar during arthroscopic shoulder surgery under both brachial plexus blocks. However, SCBPB produces a better motor blockade and a lower incidence of Horner's syndrome than ISBPB.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Even distribution of local anesthetics around the brachial plexus located lateral and cephalad to the subclavian artery after supraclavicular brachial plexus block. BP = brachial plexus; FR = first rib; PL = pleura; SA = subclavian artery.
FIGURE 2
FIGURE 2
Proximal spread of local anesthetics to the interscalene groove after supraclavicular brachial plexus block. ASM = anterior scalene muscle; BP = brachial plexus; LA = local anesthetics; MSM = middle scalene muscle.
FIGURE 3
FIGURE 3
CONSORT diagram. ISBPB = interscalene brachial plexus block; SCBPB = supraclavicular brachial plexus block.

References

    1. Brown DL, Bridenbaugh LD. Cousins MJ, Bridenbaugh PO. The upper extremity somatic block. Neural Blockade in Clinical Anesthesia and Pain Medicine. Philadelphia:Lippincott Williams & Wilkins, a Wolters Kluwer business; 2009. 316–342.
    1. Moore DC, Bridenbaugh LD, Eather KF. Block of the upper extremity. Arch Surg 1965; 90:68–72.
    1. Kakazu C, Tokhner V, Li J, et al. In the new era of ultrasound guidance: is pneumothorax from supraclavicular block a rare complication of the past? Br J Anaesth 2014; 113:190–191.
    1. Warren J, Thoma RB, Georgescu A, et al. Intravenous lipid infusion in the successful resuscitation of local anesthetic-induced cardiovascular collapse after supraclavicular brachial plexus block. Anesth Analg 2008; 106:1578–1580.
    1. Fredrickson MJ, Krishnan S, Chen CY. Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques. Anaesthesia 2010; 65:608–624.
    1. Sadowski M, Tulaza B, Lysenko L. Renaissance of supraclavicular brachial plexus block. Anaesthesiol Intensive Ther 2014; 46:37–41.
    1. Liu SS, Gordon MA, Shaw PM, et al. A prospective clinical registry of ultrasound-guided regional anesthesia for ambulatory shoulder surgery. Anesth Analg 2010; 111:617–623.
    1. Song JG, Jeon DG, Kang BJ, et al. Minimum effective volume of mepivacaine for ultrasound-guided supraclavicular block. Korean J Anesthesiol 2013; 65:37–41.
    1. Kessler J, Marhofer P, Hopkins PM, et al. Peripheral regional anaesthesia and outcome: lessons learned from the last 10 years. Br J Anaesth 2015; 114:728–745.
    1. Kessler J, Schafhalter-Zoppoth I, Gray AT. An ultrasound study of the phrenic nerve in the posterior cervical triangle: implications for the interscalene brachial plexus block. Reg Anesth Pain Med 2008; 33:545–550.
    1. Gadsden J, Hadzic A, Gandhi K, et al. The effect of mixing 1.5% mepivacaine and 0.5% bupivacaine on duration of analgesia and latency of block onset in ultrasound-guided interscalene block. Anesth Analg 2011; 112:471–476.
    1. Kapral S, Greher M, Huber G, et al. Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth Pain Med 2008; 33:253–258.
    1. Bigeleisen PE, Moayeri N, Groen GJ. Extraneural versus intraneural stimulation thresholds during ultrasound-guided supraclavicular block. Anesthesiology 2009; 110:1235–1243.
    1. Keegan JJ, Garrett FD. The segmental distribution of the cutaneous nerves in the limbs of man. Anat Rec 1948; 102:409–437.
    1. Kapral S, Krafft P, Eibenberger K, et al. Ultrasound-guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesth Analg 1994; 78:507–513.
    1. Vester-Andersen T, Christiansen C, Hansen A, et al. Interscalene brachial plexus block: area of analgesia, complications and blood concentrations of local anesthetics. Acta Anaesthesiol Scand 1981; 25:81–84.
    1. Seo KC, Park JS, Roh WS. Factors contributing to episodes of bradycardia hypotension during shoulder arthroscopic surgery in the sitting position after interscalene block. Korean J Anesthesiol 2010; 58:38–44.
    1. Lanz E, Theiss D, Jankovic D. The extent of blockade following various techniques of brachial plexus block. Anesth Analg 1983; 62:55–58.
    1. Liguori GA, Kahn RL, Gordon J, et al. The use of metoprolol and glycopyrrolate to prevent hypotensive/bradycardic events during shoulder arthroscopy in the sitting position under interscalene block. Anesth Analg 1998; 87:1320–1325.
    1. Perlas A, Lobo G, Lo N, et al. Ultrasound-guided supraclavicular block: outcome of 510 consecutive cases. Reg Anesth Pain Med 2009; 34:171–176.
    1. Cornish P. Supraclavicular block—new perspectives. Reg Anesth Pain Med 2009; 34:607–608.
    1. Gautier P, Vandepitte C, Ramquet C, et al. The minimum effective anesthetic volume of 0.75% ropivacaine in ultrasound-guided interscalene brachial plexus block. Anesth Analg 2011; 113:951–955.
    1. Netter FN. Atlas of Human Anatomy. Philadelphia:Saunders Elsevier; 2006.
    1. Moore KL. Clinically Oriented Anatomy. Philadelphia:Lippincott Williams & Wilkins; 1999.
    1. Arad E, Li Z, Sitzman TJ, et al. Anatomic sites of origin of the suprascapular and lateral pectoral nerves within the brachial plexus. Plast Reconstr Surg 2014; 133:20e–27e.
    1. Neal JM, Gerancher JC, Hebl JR, et al. Upper extremity regional anesthesia: essentials of our current understanding, 2008. Reg Anesth Pain Med 2009; 34:134–170.
    1. Royse CE, Sha S, Soeding PF, et al. Anatomical study of the brachial plexus using surface ultrasound. Anaesth Intensive Care 2006; 34:203–210.
    1. Martinoli C, Bianchi S, Santacroce E, et al. Brachial plexus sonography: a technique for assessing the root level. Am J Roentgenol 2002; 179:699–702.
    1. Dewees JL, Schultz CT, Wilkerson FK, et al. Comparison of two approaches to brachial plexus anesthesia for proximal upper extremity surgery: interscalene and intersternocleidomastoid. AANA J 2006; 74:201–206.
    1. Gonano C, Kettner SC, Ernstbrunner M, et al. Comparison of economical aspects of interscalene brachial plexus blockade and general anaesthesia for arthroscopic shoulder surgery. Br J Anaesth 2009; 103:428–433.
    1. Hanumanthaiah D, Vaidiyanathan S, Garstka M, et al. Ultrasound guided supraclavicular block. Med Ultrason 2013; 15:224–229.
    1. Hickey R, Garland TA, Ramamurthy S. Subclavian perivascular block: influence of location of paresthesia. Anesth Analg 1989; 68:767–771.
    1. Neal JM, Hebl JR, Gerancher JC, et al. Brachial plexus anesthesia: essentials of our current understanding. Reg Anesth Pain Med 2002; 27:402–428.
    1. Munirama S, McLeod G. A systematic review and meta-analysis of ultrasound versus electrical stimulation for peripheral nerve location and blockade. Anaesthesia 2015; 70:1084–1091.
    1. Gurkan Y, Tekin M, Acar S, et al. Is nerve stimulation needed during an ultrasound-guided lateral sagittal infraclavicular block? Acta Anaesthesiol Scand 2010; 54:403–407.
    1. Dingemans E, Williams SR, Arcand G, et al. Neurostimulation in ultrasound-guided infraclavicular block: a prospective randomized trial. Anesth Analg 2007; 104:1275–1280.tables of contents.
    1. Chan VW, Perlas A, McCartney CJ, et al. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth 2007; 54:176–182.
    1. Sites BD, Beach ML, Chinn CD, et al. A comparison of sensory and motor loss after a femoral nerve block conducted with ultrasound versus ultrasound and nerve stimulation. Reg Anesth Pain Med 2009; 34:508–513.
    1. Cohen JM, Gray AT. Functional deficits after intraneural injection during interscalene block. Reg Anesth Pain Med 2010; 35:397–399.
    1. Reiss W, Kurapati S, Shariat A, et al. Nerve injury complicating ultrasound/electrostimulation-guided supraclavicular brachial plexus block. Reg Anesth Pain Med 2010; 35:400–401.

Source: PubMed

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