Yumin Jo, Chahyun Oh, Woo-Yong Lee, Donggeun Lee, Suyeon Shin, Woosuk Chung, Chaeseong Lim, Sun Yeul Lee, Boohwi Hong
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引用次数: 0
Abstract
Background: Inter-scalene block (ISB) is associated with an inevitable risk of hemi-diaphragmatic paresis (HDP). To reduce the risk of HDP, an upper trunk block (UTB) has been proposed at the brachial plexus division level.
Objective: We hypothesised that UTB would be associated with a lower incidence of HDP than ISB while providing sufficient analgesia following arthroscopic shoulder surgery.
Design: Randomised controlled trial.
Setting: A tertiary teaching hospital.
Patients: Seventy patients aged 20 to 80 years undergoing arthroscopic rotator cuff repair.
Intervention: Ultrasound-guided ISB or UTB was performed with 5 ml 0.75% ropivacaine.
Main outcome measures: The primary outcome was the incidence of complete HDP, assessed by diaphragm excursion using ultrasound, defined as a decrease to 25% or less of baseline or occurrence of paradoxical movement. Postoperative pulmonary function change, pain scores, opioid consumption and pain-related outcomes were the secondary outcomes.
Results: The UTB group had a significantly lower incidence of complete HDP than the ISB group [5.9% (2/34) vs. 41.7% (15/36); absolute difference, 35.8%; 95% confidence interval (CI), 17.8 to 53.7%; P < 0.001]. The postblockade decline in pulmonary function was more pronounced in the ISB group than that in the UTB group. The pain score at 1 h postoperatively was not significantly different between the groups (ISB vs. UTB group: median 0 vs. 1; median difference, -1; 95% CI, -2 to 0.5). No significant difference was observed in any other secondary outcomes.
Conclusion: UTB was associated with a lower incidence of HDP compared with ISB while providing excellent analgesia in arthroscopic shoulder surgery.
Trial registration: Clinical Trial Registry of Korea ( https://cris.nih.go.kr ) identifier: KCT0007002.
Irb number: Chungnam National University Hospital Institutional Review Board No. 2021-12-069.
期刊介绍：
The European Journal of Anaesthesiology (EJA) publishes original work of high scientific quality in the field of anaesthesiology, pain, emergency medicine and intensive care. Preference is given to experimental work or clinical observation in man, and to laboratory work of clinical relevance. The journal also publishes commissioned reviews by an authority, editorials, invited commentaries, special articles, pro and con debates, and short reports (correspondences, case reports, short reports of clinical studies).
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