The effects of shoulder arthroscopy on ultrasound image quality of the interscalene brachial plexus: a pre-procedure vs post-procedure comparative study

Jason K Panchamia, Ram Jagannathan, Bridget P Pulos, Adam W Amundson, Joaquin Sanchez-Sotelo, David P Martin, Hugh M Smith, Jason K Panchamia, Ram Jagannathan, Bridget P Pulos, Adam W Amundson, Joaquin Sanchez-Sotelo, David P Martin, Hugh M Smith

Abstract

Background: Fluid extravasation from the shoulder compartment and subsequent absorption into adjacent soft tissue is a well-documented phenomenon in arthroscopic shoulder surgery. We aimed to determine if a qualitative difference in ultrasound imaging of the interscalene brachial plexus exists in relation to the timing of performing an interscalene nerve block (preoperative or postoperative).

Methods: This single-center, prospective observational study compared pre- and postoperative interscalene brachial plexus ultrasound images of 29 patients undergoing shoulder arthroscopy using a pretest-posttest methodology where individual patients served as their own controls. Three fellowship-trained regional anesthesiologists evaluated image quality and confidence in performing a block for each ultrasound scan using a five-point Likert scale. The association of image quality with age, gender, BMI, duration of surgery, obstructive sleep apnea, and volume of arthroscopic irrigation fluid were analyzed as secondary outcomes.

Results: Aggregate preoperative mean scores in quality of ultrasound visualization were higher than postoperative scores (preoperative 4.5 vs postoperative 3.8; p < .001), as was confidence in performing blockade based upon the imaging (preoperative 4.8 vs postoperative 4.2; p < .001). Larger BMI negatively affected visualization of the brachial plexus in the preoperative period (p < 0.05 for both weight categories). Patients with intermediate-high risk or confirmed obstructive sleep apnea had lower aggregate postoperative mean scores compared to the low-risk group for both ultrasound visualization (3.4 vs 4.0; p < .05) and confidence in block performance (3.8 vs 4.4; p < .05).

Conclusion: Due to the potential reduction of ultrasound visualization of the interscalene brachial plexus after shoulder arthroscopy, we advocate for a preoperative interscalene nerve block when feasible.

Trial registration: ClinicalTrials.gov ( NCT03657173 ; September 4, 2018).

Keywords: Arthroscopy; Brachial plexus block; Extravasation of diagnostic and therapeutic materials; Ultrasonography.

Conflict of interest statement

The authors declare that they have no competing interests. Dr. Sanchez-Sotelo reports personal fees from Consultant for Wright, grants and personal fees from Stryker Royalties, personal fees from Consultant for Exactech, other from PrecisionOS, personal fees from Journal Editor for Journal of Shoulder and Elbow Surgery, other from PSI, personal fees from Elsevier, personal fees from Oxford University Press. All disclosures do not compete with this investigation, are outside the submitted work, and do not influence the results and/or discussion reported in this paper.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Reviewer scoring system for pre- and postoperative ultrasound examination using five-point Likert scale

References

    1. Panchamia JK, Amundson AW, Jacob AK, Sviggum HP, Nguyen NTV, Sanchez-Sotelo J, Sperling JW, Schroeder DR, Kopp SL, Johnson RL. A 3-arm randomized clinical trial comparing interscalene blockade techniques with local infiltration analgesia for total shoulder arthroplasty. J Shoulder Elb Surg. 2019;28(10):e325–e338. doi: 10.1016/j.jse.2019.05.013.
    1. Yan S, Zhao Y, Zhang H. Efficacy and safety of interscalene block combined with general anesthesia for arthroscopic shoulder surgery: a meta-analysis. J Clin Anesth. 2018;47:74–79. doi: 10.1016/j.jclinane.2018.03.008.
    1. Chellam S, Chiplonkar S, Pathak K. Change in neck circumference after shoulder arthroscopy: an observational study. Indian J Anaesth. 2015;59(6):365–368. doi: 10.4103/0019-5049.158742.
    1. Cohen JM, Gray AT. Functional deficits after intraneural injection during interscalene block. Reg Anesth Pain Med. 2010;35(4):397–399. doi: 10.1097/AAP.0b013e3181e8a35f.
    1. Panchamia JK, Olsen DA, Amundson AW. Unique phrenic nerve-sparing regional anesthetic technique for pain management after shoulder surgery. Case Rep Anesthesiol. 2017;2017:1294913.
    1. Montoro E, Ferre F, Yonis H, Gris C, Minville V. Pneumothorax as a complication of ultrasound-guided interscalene block for shoulder surgery. Eur J Anaesthesiol. 2013;30(2):90–91. doi: 10.1097/EJA.0b013e3283564714.
    1. Hebl JR, Dilger JA, Byer DE, Kopp SL, Stevens SR, Pagnano MW, Hanssen AD, Horlocker TT. A pre-emptive multimodal pathway featuring peripheral nerve block improves perioperative outcomes after major orthopedic surgery. Reg Anesth Pain Med. 2008;33(6):510–517. doi: 10.1097/00115550-200811000-00002.
    1. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–1457. doi: 10.1016/S0140-6736(07)61602-X.
    1. Neuts A, Stessel B, Wouters PF, Dierickx C, Cools W, Ory JP, Dubois J, Jamaer L, Arijs I, Schoorens D. Selective suprascapular and axillary nerve block versus interscalene plexus block for pain control after arthroscopic shoulder surgery: a noninferiority randomized parallel-controlled clinical trial. Reg Anesth Pain Med. 2018;43(7):738–744. doi: 10.1097/AAP.0000000000000777.
    1. Stolz LA, Acuna JG, Gaskin K, Murphy AM, Friedman L, Stears-Ellis S, Javedani P, Stolz U, Adhikari S. Echogenicity and ultrasound visibility of peripheral nerves of the upper extremity. Med Ultrason. 2018;20(2):199–204. doi: 10.11152/mu-1240.
    1. Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108(5):812–821. doi: 10.1097/ALN.0b013e31816d83e4.
    1. Hanouz JL, Grandin W, Lesage A, Oriot G, Bonnieux D, Gerard JL. Multiple injection axillary brachial plexus block: influence of obesity on failure rate and incidence of acute complications. Anesth Analg. 2010;111(1):230–233. doi: 10.1213/ANE.0b013e3181dde023.
    1. Schroeder K, Andrei AC, Furlong MJ, Donnelly MJ, Han S, Becker AM. The perioperative effect of increased body mass index on peripheral nerve blockade: an analysis of 528 ultrasound guided interscalene blocks. Rev Bras Anestesiol. 2012;62(1):28–38. doi: 10.1016/S0034-7094(12)70100-9.
    1. Ingrande J, Brodsky JB, Lemmens HJ. Regional anesthesia and obesity. Curr Opin Anaesthesiol. 2009;22(5):683–686. doi: 10.1097/ACO.0b013e32832eb7bd.
    1. Vier BR, Mombell KW, Gagliano EL, King NM, McDonald LS. Extravasation of fluid in arthroscopic shoulder surgery requiring prolonged intubation: a case report. Patient Saf Surg. 2019;13(1):21. doi: 10.1186/s13037-019-0202-8.
    1. Orebaugh SL. Life-threatening airway edema resulting from prolonged shoulder arthroscopy. Anesthesiology. 2003;99(6):1456–1458. doi: 10.1097/00000542-200312000-00034.
    1. Blumenthal S, Nadig M, Gerber C, Borgeat A. Severe airway obstruction during arthroscopic shoulder surgery. Anesthesiology. 2003;99(6):1455–1456. doi: 10.1097/00000542-200312000-00033.
    1. Memon M, Kay J, Gholami A, Simunovic N, Ayeni OR. Fluid extravasation in shoulder arthroscopic surgery: a systematic review. Orthop J Sports Med. 2018;6(5):2325967118771616. doi: 10.1177/2325967118771616.
    1. Catal B, Azboy I. Fluid retention after shoulder arthroscopy: gravity flow vs. automated pump-a prospective randomized study. J Shoulder Elb Surg. 2019;28(10):1911–1917. doi: 10.1016/j.jse.2019.05.041.
    1. Burk RS, Grap MJ, Lucas V, Munro CL, Wetzel PA, Schubert CM. High-frequency ultrasound: obtaining optimal images and the effect of image artifacts on image quality. Adv Wound Care (New Rochelle) 2017;6(11):383–391. doi: 10.1089/wound.2017.0727.
    1. Bosco L, Zhou C, Murdoch JAC, Bicknell R, Hopman WM, Phelan R, Shyam V. Pre- or postoperative interscalene block and/or general anesthesia for arthroscopic shoulder surgery: a retrospective observational study. Can J Anaesth. 2017;64(10):1048–1058. doi: 10.1007/s12630-017-0937-6.
    1. Brown AR, Weiss R, Greenberg C, Flatow EL, Bigliani LU. Interscalene block for shoulder arthroscopy: comparison with general anesthesia. Arthroscopy. 1993;9(3):295–300. doi: 10.1016/S0749-8063(05)80425-6.
    1. Choi S, Kim T, Kwon YS, Kang H. Intra-operative effect of interscalene brachial plexus block to arthroscopic rotator cuff repair surgery. Int Orthop. 2019;43(9):2117–2124. doi: 10.1007/s00264-018-4199-x.
    1. Karmakar MK, Ho AM, Li X, Kwok WH, Tsang K, Ngan Kee WD. Ultrasound-guided lumbar plexus block through the acoustic window of the lumbar ultrasound trident. Br J Anaesth. 2008;100(4):533–537. doi: 10.1093/bja/aen026.
    1. Karmakar MK, Shariat AN, Pangthipampai P, Chen J. High-definition ultrasound imaging defines the paraneural sheath and the fascial compartments surrounding the sciatic nerve at the popliteal fossa. Reg Anesth Pain Med. 2013;38(5):447–451. doi: 10.1097/AAP.0b013e31829ffcb4.
    1. Gray AT. Ultrasound-guided regional anesthesia: current state of the art. Anesthesiology. 2006;104(2):368–373. doi: 10.1097/00000542-200602000-00024.

Source: PubMed

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