Continuous interscalene brachial plexus nerve block prolongs unilateral diaphragmatic dysfunction
Abstract Background and objectives Single interscalene blocks (ISB) impair pulmonary function (< 24 h). We hypothesized that continuous ISBs would prolong pulmonary dysfunction until h48 compared with a single ISB. We compared the time course of spirometric and diaphragmatic dysfunction following...
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| Veröffentlicht in: | Anaesthesia critical care & pain medicine 2016-12, Vol.35 (6), p.383-390 |
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| creator | Cuvillon, Philippe Le Sache, Frederic Demattei, Christophe Lidzborski, Lionel Zoric, Lana Riou, Bruno Langeron, Olivier Raux, Mathieu |
| description | Abstract Background and objectives Single interscalene blocks (ISB) impair pulmonary function (< 24 h). We hypothesized that continuous ISBs would prolong pulmonary dysfunction until h48 compared with a single ISB. We compared the time course of spirometric and diaphragmatic dysfunction following single or continuous ISBs. Methods We prospectively included consecutive adult patients scheduled to undergo shoulder surgery under standard general anaesthesia with single ( n = 30) or continuous ( n = 31) ISB. Before ISB (baseline), spirometric tests were recorded and the diaphragm course was evaluated with a B-mode ultrasound technique every 12 h until h48. ISBs were performed with 15 mL 0.5% ropivacaine using an ultrasound technique approach. The continuous group received the same bolus followed by 0.2% ropivacaine 5 mL·h−1 (48 h). The primary end point was the reduction (> 25% from baseline) of forced vital capacity (FVC) over the study period (48 h). Results Patient characteristics were similar in both groups. Thirty minutes after blocks in the PACU, all patients demonstrated a similar and significant unilateral diaphragm paralysis ( |
| doi_str_mv | 10.1016/j.accpm.2016.01.009 |
| format | Article |
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We hypothesized that continuous ISBs would prolong pulmonary dysfunction until h48 compared with a single ISB. We compared the time course of spirometric and diaphragmatic dysfunction following single or continuous ISBs. Methods We prospectively included consecutive adult patients scheduled to undergo shoulder surgery under standard general anaesthesia with single ( n = 30) or continuous ( n = 31) ISB. Before ISB (baseline), spirometric tests were recorded and the diaphragm course was evaluated with a B-mode ultrasound technique every 12 h until h48. ISBs were performed with 15 mL 0.5% ropivacaine using an ultrasound technique approach. The continuous group received the same bolus followed by 0.2% ropivacaine 5 mL·h−1 (48 h). The primary end point was the reduction (> 25% from baseline) of forced vital capacity (FVC) over the study period (48 h). Results Patient characteristics were similar in both groups. Thirty minutes after blocks in the PACU, all patients demonstrated a similar and significant unilateral diaphragm paralysis (< 25% from baseline). For the primary end point (FVC), no significant difference was observed between groups over the study period. A difference between single and continuous groups was observed at h24 for: FVC (–25%, P = 0.038), FEV1s (–24%, P = 0.036), diaphragmatic course (–26%, P = 0.02), while no differences for other time points (h0–h48) were noted. Clinical respiratory evaluations (respiratory rate, SpO2 , supplementary nasal O2 ), postoperative pain scores and additional opioid consumption were similar between groups. Conclusion Over infusion, continuous ISB did not significantly prolong unilateral phrenic paresis and demonstrated a limited pulmonary impact.</description><identifier>ISSN: 2352-5568</identifier><identifier>EISSN: 2352-5568</identifier><identifier>DOI: 10.1016/j.accpm.2016.01.009</identifier><identifier>PMID: 27329990</identifier><language>eng</language><publisher>France: Elsevier Masson SAS</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Amides ; Anaesthetic techniques ; Anaesthetics techniques ; Anesthesia & Perioperative Care ; Anesthesia Recovery Period ; Anesthesia, General ; Anesthetics, Local ; Brachial Plexus ; Continuous interscalene ; Diaphragm - diagnostic imaging ; Diaphragm - physiopathology ; Evaluation ; Female ; Human health and pathology ; Humans ; Life Sciences ; Male ; Middle Aged ; Nerve Block - adverse effects ; Oxygen - blood ; Pain, Postoperative - epidemiology ; Regional ; Respiratory Function Tests ; Shoulder - surgery ; Spirometry ; Ultrasonography, Interventional ; Vital Capacity ; Young Adult</subject><ispartof>Anaesthesia critical care & pain medicine, 2016-12, Vol.35 (6), p.383-390</ispartof><rights>2016</rights><rights>Copyright © 2016. Published by Elsevier Masson SAS.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c518t-3e0f1e02db3b1023cba47bc6dadbd9fa38e7764d2d32a315e7950e93c53ba11f3</citedby><cites>FETCH-LOGICAL-c518t-3e0f1e02db3b1023cba47bc6dadbd9fa38e7764d2d32a315e7950e93c53ba11f3</cites><orcidid>0000-0002-4424-4280 ; 0000-0003-1205-4738 ; 0000-0001-6955-9281</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27329990$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-01904121$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Cuvillon, Philippe</creatorcontrib><creatorcontrib>Le Sache, Frederic</creatorcontrib><creatorcontrib>Demattei, Christophe</creatorcontrib><creatorcontrib>Lidzborski, Lionel</creatorcontrib><creatorcontrib>Zoric, Lana</creatorcontrib><creatorcontrib>Riou, Bruno</creatorcontrib><creatorcontrib>Langeron, Olivier</creatorcontrib><creatorcontrib>Raux, Mathieu</creatorcontrib><title>Continuous interscalene brachial plexus nerve block prolongs unilateral diaphragmatic dysfunction</title><title>Anaesthesia critical care & pain medicine</title><addtitle>Anaesth Crit Care Pain Med</addtitle><description>Abstract Background and objectives Single interscalene blocks (ISB) impair pulmonary function (< 24 h). We hypothesized that continuous ISBs would prolong pulmonary dysfunction until h48 compared with a single ISB. We compared the time course of spirometric and diaphragmatic dysfunction following single or continuous ISBs. Methods We prospectively included consecutive adult patients scheduled to undergo shoulder surgery under standard general anaesthesia with single ( n = 30) or continuous ( n = 31) ISB. Before ISB (baseline), spirometric tests were recorded and the diaphragm course was evaluated with a B-mode ultrasound technique every 12 h until h48. ISBs were performed with 15 mL 0.5% ropivacaine using an ultrasound technique approach. The continuous group received the same bolus followed by 0.2% ropivacaine 5 mL·h−1 (48 h). The primary end point was the reduction (> 25% from baseline) of forced vital capacity (FVC) over the study period (48 h). Results Patient characteristics were similar in both groups. Thirty minutes after blocks in the PACU, all patients demonstrated a similar and significant unilateral diaphragm paralysis (< 25% from baseline). For the primary end point (FVC), no significant difference was observed between groups over the study period. A difference between single and continuous groups was observed at h24 for: FVC (–25%, P = 0.038), FEV1s (–24%, P = 0.036), diaphragmatic course (–26%, P = 0.02), while no differences for other time points (h0–h48) were noted. Clinical respiratory evaluations (respiratory rate, SpO2 , supplementary nasal O2 ), postoperative pain scores and additional opioid consumption were similar between groups. Conclusion Over infusion, continuous ISB did not significantly prolong unilateral phrenic paresis and demonstrated a limited pulmonary impact.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Amides</subject><subject>Anaesthetic techniques</subject><subject>Anaesthetics techniques</subject><subject>Anesthesia & Perioperative Care</subject><subject>Anesthesia Recovery Period</subject><subject>Anesthesia, General</subject><subject>Anesthetics, Local</subject><subject>Brachial Plexus</subject><subject>Continuous interscalene</subject><subject>Diaphragm - diagnostic imaging</subject><subject>Diaphragm - physiopathology</subject><subject>Evaluation</subject><subject>Female</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Life Sciences</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nerve Block - adverse effects</subject><subject>Oxygen - blood</subject><subject>Pain, Postoperative - epidemiology</subject><subject>Regional</subject><subject>Respiratory Function Tests</subject><subject>Shoulder - surgery</subject><subject>Spirometry</subject><subject>Ultrasonography, Interventional</subject><subject>Vital Capacity</subject><subject>Young Adult</subject><issn>2352-5568</issn><issn>2352-5568</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkkFv1DAQhSMEolXpL0BCOcJhw9heJ5sDSNUKKNJKHICzNbEnXW8dO9jJiv33OGypEBdOtsffm5Hfc1G8ZFAxYPXbQ4Vaj0PF86ECVgG0T4pLLiRfSVlvnv61vyiuUzoAAFvXjWib58UFbwRv2xYuC9wGP1k_hzmV1k8Uk0ZHnsouot5bdOXo6Ge-9BSPueqCvi_HGFzwd6mcvXWYRRkzFsd9xLsBJ6tLc0r97PVkg39RPOvRJbp-WK-K7x8_fNvernZfPn3e3uxWWrLNtBIEPSPgphMdAy50h-um07VB05m2R7GhpqnXhhvBUTBJTSuBWqGl6JCxXlwVb8599-jUGO2A8aQCWnV7s1NLDVgLa8bZkWX29ZnNL_kxU5rUYJMm59BTdkKxDa-b7JeUGRVnVMeQUqT-sTcDtUShDup3FGqJIg9ROYqsevUwYO4GMo-aP8Zn4N0ZoGzJ0VJUSVvymoyNpCdlgv3PgPf_6LWz3ubw7ulE6RDm6LPbiqnEFaivy29YPgOrBYDkXPwCSIKxZg</recordid><startdate>20161201</startdate><enddate>20161201</enddate><creator>Cuvillon, Philippe</creator><creator>Le Sache, Frederic</creator><creator>Demattei, Christophe</creator><creator>Lidzborski, Lionel</creator><creator>Zoric, Lana</creator><creator>Riou, Bruno</creator><creator>Langeron, Olivier</creator><creator>Raux, Mathieu</creator><general>Elsevier Masson SAS</general><general>Elsevier Masson</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0002-4424-4280</orcidid><orcidid>https://orcid.org/0000-0003-1205-4738</orcidid><orcidid>https://orcid.org/0000-0001-6955-9281</orcidid></search><sort><creationdate>20161201</creationdate><title>Continuous interscalene brachial plexus nerve block prolongs unilateral diaphragmatic dysfunction</title><author>Cuvillon, Philippe ; Le Sache, Frederic ; Demattei, Christophe ; Lidzborski, Lionel ; Zoric, Lana ; Riou, Bruno ; Langeron, Olivier ; Raux, Mathieu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c518t-3e0f1e02db3b1023cba47bc6dadbd9fa38e7764d2d32a315e7950e93c53ba11f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Amides</topic><topic>Anaesthetic techniques</topic><topic>Anaesthetics techniques</topic><topic>Anesthesia & Perioperative Care</topic><topic>Anesthesia Recovery Period</topic><topic>Anesthesia, General</topic><topic>Anesthetics, Local</topic><topic>Brachial Plexus</topic><topic>Continuous interscalene</topic><topic>Diaphragm - diagnostic imaging</topic><topic>Diaphragm - physiopathology</topic><topic>Evaluation</topic><topic>Female</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Life Sciences</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Nerve Block - adverse effects</topic><topic>Oxygen - blood</topic><topic>Pain, Postoperative - epidemiology</topic><topic>Regional</topic><topic>Respiratory Function Tests</topic><topic>Shoulder - surgery</topic><topic>Spirometry</topic><topic>Ultrasonography, Interventional</topic><topic>Vital Capacity</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cuvillon, Philippe</creatorcontrib><creatorcontrib>Le Sache, Frederic</creatorcontrib><creatorcontrib>Demattei, Christophe</creatorcontrib><creatorcontrib>Lidzborski, Lionel</creatorcontrib><creatorcontrib>Zoric, Lana</creatorcontrib><creatorcontrib>Riou, Bruno</creatorcontrib><creatorcontrib>Langeron, Olivier</creatorcontrib><creatorcontrib>Raux, Mathieu</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Anaesthesia critical care & pain medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cuvillon, Philippe</au><au>Le Sache, Frederic</au><au>Demattei, Christophe</au><au>Lidzborski, Lionel</au><au>Zoric, Lana</au><au>Riou, Bruno</au><au>Langeron, Olivier</au><au>Raux, Mathieu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Continuous interscalene brachial plexus nerve block prolongs unilateral diaphragmatic dysfunction</atitle><jtitle>Anaesthesia critical care & pain medicine</jtitle><addtitle>Anaesth Crit Care Pain Med</addtitle><date>2016-12-01</date><risdate>2016</risdate><volume>35</volume><issue>6</issue><spage>383</spage><epage>390</epage><pages>383-390</pages><issn>2352-5568</issn><eissn>2352-5568</eissn><abstract>Abstract Background and objectives Single interscalene blocks (ISB) impair pulmonary function (< 24 h). We hypothesized that continuous ISBs would prolong pulmonary dysfunction until h48 compared with a single ISB. We compared the time course of spirometric and diaphragmatic dysfunction following single or continuous ISBs. Methods We prospectively included consecutive adult patients scheduled to undergo shoulder surgery under standard general anaesthesia with single ( n = 30) or continuous ( n = 31) ISB. Before ISB (baseline), spirometric tests were recorded and the diaphragm course was evaluated with a B-mode ultrasound technique every 12 h until h48. ISBs were performed with 15 mL 0.5% ropivacaine using an ultrasound technique approach. The continuous group received the same bolus followed by 0.2% ropivacaine 5 mL·h−1 (48 h). The primary end point was the reduction (> 25% from baseline) of forced vital capacity (FVC) over the study period (48 h). Results Patient characteristics were similar in both groups. Thirty minutes after blocks in the PACU, all patients demonstrated a similar and significant unilateral diaphragm paralysis (< 25% from baseline). For the primary end point (FVC), no significant difference was observed between groups over the study period. A difference between single and continuous groups was observed at h24 for: FVC (–25%, P = 0.038), FEV1s (–24%, P = 0.036), diaphragmatic course (–26%, P = 0.02), while no differences for other time points (h0–h48) were noted. Clinical respiratory evaluations (respiratory rate, SpO2 , supplementary nasal O2 ), postoperative pain scores and additional opioid consumption were similar between groups. Conclusion Over infusion, continuous ISB did not significantly prolong unilateral phrenic paresis and demonstrated a limited pulmonary impact.</abstract><cop>France</cop><pub>Elsevier Masson SAS</pub><pmid>27329990</pmid><doi>10.1016/j.accpm.2016.01.009</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-4424-4280</orcidid><orcidid>https://orcid.org/0000-0003-1205-4738</orcidid><orcidid>https://orcid.org/0000-0001-6955-9281</orcidid></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Amides Anaesthetic techniques Anaesthetics techniques Anesthesia & Perioperative Care Anesthesia Recovery Period Anesthesia, General Anesthetics, Local Brachial Plexus Continuous interscalene Diaphragm - diagnostic imaging Diaphragm - physiopathology Evaluation Female Human health and pathology Humans Life Sciences Male Middle Aged Nerve Block - adverse effects Oxygen - blood Pain, Postoperative - epidemiology Regional Respiratory Function Tests Shoulder - surgery Spirometry Ultrasonography, Interventional Vital Capacity Young Adult |
| title | Continuous interscalene brachial plexus nerve block prolongs unilateral diaphragmatic dysfunction |
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