Respiratory impact of local anaesthetic volume after an interscalene brachial plexus block with an extrafascial injection: a randomised controlled double-blinded trial.
Yves Renard, Sina Grape, Erin Gonvers, Jean-Benoit Rossel, Patrick Goetti, Eric Albrecht
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Abstract
Background: We have previously demonstrated that an extrafascial injection of 20 ml of local anaesthetic for interscalene brachial plexus block (ISB) reduces the rate of hemidiaphragmatic paralysis by 70% compared with an intrafascial injection, with similar efficacy. In this double-blind trial, we tested the hypothesis that a local anaesthetic volume of 10 ml injected extrafascially would reduce the rate of hemidiaphragmatic paralysis vs a volume of 20 ml, while providing similar analgesia.
Methods: Sixty ASA physical status 1-3 patients scheduled for elective shoulder surgery under general anaesthesia were randomised to receive ultrasound-guided extrafascial ISB using ropivacaine 0.75% 20 ml (control group) or 10 ml (low-volume group) injected lateral to the brachial plexus sheath. The primary outcome was incidence of hemidiaphragmatic paralysis (diaphragmatic excursion reduction of >75%), measured by M-mode ultrasonography, at 30 min after the procedure. Secondary outcomes included duration of analgesia and i.v. morphine consumption at 24 h after surgery.
Results: The 30-min hemidiaphragmatic paralysis rate was 80% (95% confidence interval [CI] 61-91%) in the control group and 19% (95% CI 8-40%) in the low-volume group (P<0.001). Participants in the low-volume vs control group had a shorter duration of analgesia (550 vs 873 min; P<0.01) and higher i.v. morphine consumption (20 vs 12 mg; P=0.03).
Conclusions: A low volume of local anaesthetic injected extrafascially reduced the rate of hemidiaphragmatic paralysis, but at the expense of a shorter duration of analgesia compared with standard-dose extrafascial anaesthetic injection.
期刊介绍：
The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience.
The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence.
Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.
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