Comparative evaluation of regional blockades during arthroscopic shoulder surgery

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Abstract

Objective: To evaluate the effectiveness of interscalene brachial plexus block versus combined suprascapular and axillary nerves block for shoulder arthroscopy. Methods: In this prospective study 174 patients were operated on the shoulder joint by the arthroscopic method under combined anesthesia. In the 1st group (n=96), for the purpose of analgesia, patients got interscalene brachial plexus block; in the 2nd group (n=78), patients received suprascapular and axillary nerves block. Ultrasound visualization and neurostimulation were used in both groups. Recorded the time from the start of blockade to the start of the operation, as well as the duration of the sensory and motor blockade. The intensity of postoperative pain was assessed with a 10-point Numeric rating scale, the need for additional analgesia, the quality of night sleep, and patient comfort. Neurological complications were also recorded.

Results: There were no differences in the time from the admit patients to the operating room and before the start surgery. The analgesic effect in the early postoperative period in the 1st group was higher, but by the end of the first day there was no statistical difference between the groups in the intensity of the pain syndrome. Intake of non-narcotic and narcotic analgesics was higher in the 2nd group. Complications were noted only for the 1st group: diaphragm paresis in 6 (6.25%) patients, in 2 (2.08%) – recurrent laryngeal nerve blockade. Satisfaction with postoperative analgesia was 100% in patients of the 2nd group. The choice of regional anesthesia for arthroscopic interventions on the shoulder did not affect the length of hospitalization.

Conclusion: Selective anesthesia of the suprascapular and axillary nerves during shoulder arthroscopic surgery is an alternative of interscalene brachial plexus block; it is not associated by respiratory and neurological complications; does not violate movements in the distal upper limb, reduces psychological discomfort and anxiety of patients.

About the authors

K. S. Trukhin

Clinic of High Medical Technologies named N. I. Pirogov, St. Petersburg State University

Email: zdv4330303@gmail.com
Russian Federation, St. Petersburg

Dmitry V. Zabolotskii

Saint-Petersburg State Pediatric Medical University of the Ministry of Healthcare of the Russian Federation

Author for correspondence.
Email: zdv4330303@gmail.com

MD, PhD, DSc, assistent-professor, Department of Anesthesiology, Reanimatology and Emergency Pediatric

Russian Federation, St. Petersburg

V. A. Koriachkin

Saint-Petersburg State Pediatric Medical University of the Ministry of Healthcare of the Russian Federation

Email: zdv4330303@gmail.com
Russian Federation, St. Petersburg

O. V. Kuleshov

Clinic of High Medical Technologies named N. I. Pirogov, St. Petersburg State University

Email: zdv4330303@gmail.com
Russian Federation, St. Petersburg

A. A. Cherednichenko

Clinic of High Medical Technologies named N. I. Pirogov, St. Petersburg State University

Email: zdv4330303@gmail.com
Russian Federation, St. Petersburg

A. Yu. Kulikov

Clinic of High Medical Technologies named N. I. Pirogov, St. Petersburg State University

Email: zdv4330303@gmail.com
Russian Federation, St. Petersburg

K. I. Zakharov

Clinic of High Medical Technologies named N. I. Pirogov, St. Petersburg State University

Email: zdv4330303@gmail.com
Russian Federation, St. Petersburg

References

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  4. Patent № 2645639 Rossiyskoy Federatsii, MPK A61M 19/00 (2006.01), A61B 8/00 (2006.01). [Tekst] / Trukhin K., S., Koryachkin V.A., Kuleshov O.V., Zabolotskiy D.V, Cherednichenko A.A., Zakharov K.I. , Dubovik V.V .; zayavitel’ i patentoobladatel’ Federal’noye gosudarstvennoye byudzhetnoye uchrezhdeniye «Sankt-Peterburgskiy mnogoprofil’nyy tsentr» Ministerstva zdravookhraneniya Rossiyskoy Federatsii (RU) – № 2016115499, zayavl. 21.04.2016; opubl. 21.02.2018-27.02.2018 Byul. No 6.
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Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Scan area for search and blockade of the supra-scapular nerve

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3. Fig. 2. Scan area to search and blockade for axillary nerve

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4. Fig. 3. The place of the supra-scapular nerve blockade in the supraspinatus fossa (the scanning plane is dorsal to the plane passing over the notch of the scapula). 1 – suprascapular nerve (blockade site), 2 – suprascapular artery, 3 – supraspinatus fossa, 4 – subcutaneous tissue, 5 – trapezius muscle, 6 – clavicle, 7 – supraspinatus muscle, 8 – anechoic shadow behind the clavicle

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5. Fig. 4. Evaluation of the retrograde spread of the local anesthetic solution – scanning plane above the scapular notch: 1 – suprascapular nerve, 2 – suprascapular artery, 3 – scapula, 4 – subcutaneous tissue, 5 – hypoechoic shadow – local anesthetic perineural, 6 – trapezius muscle, 7 – supraspinatus muscle

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6. Fig. 5. Cross-scanning with PW (pulse-wave) doppler on. Identified circumflex humeral posterior artery, at the place of its arises from the axillary artery

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7. Fig. 6. Cross-scanning (relative to the humerus) at the level of the quadrilateral foramen: 1 – axillary nerve (blockade site), 2 – axillary artery, 3 – circumflex humeral posterior artery, 4 – humerus, 5 – deltoid muscle

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8. Fig. 7. Time for blockade execution

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9. Fig. 8. The duration of the sensory block after surgery

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10. Fig. 9. The intensity of postoperative pain at rest

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