Tolga TEZER, IRFAN GÜNGOR, Gökçen EMMEZ, Ulunay KANATLI

Artroskopik Omuz Cerrahisi Sırasında İnterskalen Brakiyal Pleksus Bloğunun Analjezik ve Yan Etkilerinin Retrospektif Analizi

Amaç: İnterskalen blok (İSB), artroskopik omuz cerrahisinde anes- tezi ve perioperatif analjezi için kabul görmüş ve etkili bir yöntem hâline gelmiştir. Kombine İSB ve genel anestezi altında artroskopik omuz cerrahisi uygulanan bir hasta serisini retrospektif olarak de- ğerlendirmeyi amaçladık. Yöntem: Başarı oranları, yan etkiler ve komplikasyonlar için Hazi- ran 2007 - Ocak 2013 arasında İSB uygulanan 641 hastayı içeren retrospektif bir dosya incelemesi yapıldı. Bulgular: Genel başarılı blok oranı %96,5 ve ortalama postopera- tif analjezi süresi 15,5 saatti. Hiçbir hastada İSB’ye bağlı kalıcı sinir hasarı görülmezken, karşılaşılan en önemli komplikasyon sadece 1 hastada görülen lokal anestezik ilişkili konvülsiyondu. Sonuç: Artroskopik omuz cerrahisi uygulanan hastalarda, düşük yan etki ve komplikasyon profili ile yüksek hasta memnuniyeti sağ- layan ISB ve genel anestezi kombinasyonu önerilebilir.

A Retrospective Analysis of the Analgesic and Adverse Effects of Interscalene Brachial Plexus Block During Arthroscopic Shoulder Surgery

Objective: Interscalene block (ISB) has become an accepted and effective technique of anesthetic and perioperative analgesia, in arthroscopic shoulder surgery. We aimed to retrospectively eva- luate a series of patients who underwent arthroscopic shoulder surgery under combined ISB and general anesthesia. Methods: A retrospective chart review was performed consisting 641 patients who had ISB performed between June 2007 – Janu- ary 2013 for success rates, side effects and complications. Results: The overall success rate of the blocks was 96.5%, with a mean postoperative analgesia time of 15.5 hours. While no pa- tient suffered permanent nerve injury as a result of ISB, the most common complication noted in this analysis was local anestheti- c-related convulsion, which occurred in only one patient. Conclusion: Interscalene block and general anesthesia combinati- on, which provides high patient satisfaction with low side effects and complication profile, can be recommended for patients un- dergoing arthroscopic shoulder surgery.

PDF

___

1. Bruce BG, Green A, Blaine TA, Wesner LV. Brachial plexus blocks for upper extremity orthopaedic surgery. J Am Acad Orthop Surg 2012;20(1):38-47.
2. Borgeat A, Blumenthal S. Anaesthesia for shoulder surgery. Current Orthopaedics 2004;18(2):109-17.
3. Peruto CM, Ciccotti MG, Cohen SB. Shoulder arthroscopy positioning: lateral decubitus versus beach chair. Arthroscopy 2009;25(8):891-6.
4. Winnie AP. Interscalene brachial plexus block. Anesth Analg 1970;49(3):455-66.
5. Lenters TR, Davies J, Matsen FA 3rd. The types and severity of complications associated with interscalene brachial plexus block anesthesia: Local and national evidence. J Shoulder Elbow Surg 2007;16(4):379-87.
6. Bishop JY, Sprague M, Gelber J et al. Interscalene regional anesthesia for arthroscopic shoulder surgery: A safe and effective technique. J Shoulder Elbow Surg 2006;15(5):567- 70.
7. Misamore G, Webb B, McMurray S, Sallay P. A prospec- tive analysis of interscalene brachial plexus blocks per- formed under general anesthesia. J Shoulder Elbow Surg 2011;20(2):308-14.
8. Rohrbaugh M, Kentor ML, Orebaugh SL, Williams B. Outcomes of shoulder surgery in the sitting position with interscalene nerve block: A single-center series. Reg Anesth Pain Med 2013;38(1):28-33.
9. D’Alessio JG, Rosenblum M, Shea KP, Freitas DG. A retrospective comparison of interscalene block and general anesthesia for ambulatory surgery shoulder arthroscopy. Reg Anesth 1995;20(1):62-8.
10. Faryniarz D, Morelli C, Coleman S et al. Interscalene block anesthesia at an ambulatory surgery center performing predominantly regional anesthesia: A prospective study of one hundred thirty three patients undergoing shoulder surgery. J Shoulder Elbow Surg 2006;15(6):686-90.
11. Bert JM, Khetia E, Dubbink DA. Interscalene block for shoulder surgery in physician-owned community ambulatory surgery centers. Arthroscopy 2010;26(9):1149-52.
12. Tetzlaff JE, Yoon HJ, Brems J. Interscalene brachial plexus block for shoulder surgery. Reg Anesth 1994;19(5):339-43.
13. Moore DD, Maerz T, Anderson K. Shoulders surgeons’ perceptions of interscalene nerve blocks and a review of complications rates in theliterature. Phys Sportsmed 2013;41(3):77-84.
14. Pohl A, Cullen DJ. Cerebral ischemia during shoulder surgery in the upright position: A case series. J Clin Anesth 2005;17(6):463-9.
15. Rains DD, Rooke GA, Wahl CJ. Pathomechanisms and complications related to patient positioning and anesthesia during shoulder arthroscopy. Arthroscopy 2011;27(4):532- 41.
16. Bhatti MT, Enneking FK. Visual loss and ophthalmoplegia after shoulder surgery. Anesth Analg 2003;96(3):899-902.
17. Neal JM, Bernards CM, Butterworth JF 4th, et al. ASRA practice advisory on local anesthetic systemic toxicity. Reg Anesth Pain Med 2010;35(2):152-61.
18. Lansdown AK, McCartney CJL, Constantinescu CM, Patel SC. Regarding “a prospective analysis of interscalene brachial plexus block performed under general anesthesia”. J Shoulder Elbow Surg 2012;21(8):E16-7.
19. Kessler P, Steinfeldt T, Gogarten W, et al. Peripheral regional anesthesia in patients under general anesthesia: Risk assessment with respect to parasthesia, injection pain and nerve damage. Anaesthesist 2013;62(6):483-8.
20. Bogdanov A, Loveland R. Is there a place for interscalene block performed after induction of general anaesthesia? Eur J Anaesthesiol 2005;22(2):107-10.
21. Benumof JL. Permanent loss of cervical spinal cord function associated with interscalene block performed under general anesthesia. Anesthesiology 2000;93(6):1541-4.
22. Borgeat A, Ekatodramis G, Kalberer F, Benz C. Acute and nonacute complications associated interscalene block and shoulder surgery: A prospective study. Anesthesiology 2001;95(4):875-80.
23. Sulaiman L, Macfarlane RJ, Waseem M. Current concepts in anaesthesia for shoulder surgery. Open Orthop J 2013;7:323- 8.
24. Nishiyama T, Komatsu K. Local anesthetic toxicity in in- terscalene block: clinical series. Minerva Anestesiol 2010;76(12):1088-90.
25. Dillane D, Finucane BT. Local anesthetic systemic toxicity. Can J Anesth 2010;57(4):368-80.
26. Berde CB, Strichartz GR. Local anesthetics. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, editors. Miller’s Anesthesia. 7th ed. Philadelphia: Elsevier, Churchill Livingstone, 2009;913-40.
27. Di Gregorio G, Neal JM, Rosenquist RW, Weinberg GL. Clinical presentation of local anesthetic systemic toxicity: A review of published cases, 1979 to 2009. Reg Anesth Pain Med 2010;35(2):181-7.
28. Brown DL, Ransom DM, Hall JA, Leicht CH, Schroeder DR, Offord KP. Regional anesthesia and local anesthetic-induced systemic toxicity: Seizure frequency and accompanying cardiovascular changes. Anesth Analg 1995;81(2):321-8.
29. Orebaugh SL, Kentor ML, Williams BA. Adverse outcomes associated with nerve stimulator-guided and ultrasound- guided peripheral nerveblocks by supervised trainees: update of a single-site database. Reg Anesth Pain Med 2012;37(6):577-82.
30. Walton KA, Buono LM. Horner syndrome. Curr Opin Ophthalmol 2003;14(6):357-63.
31. Stasiowski M, Zuber M, Marciniak R, et al. Risk factors for the development of Horner’s syndrome following interscalene brachial plexus block using ropivacaine for shoulder arthroscopy: A randomised trial. Anaesthesiol Intensive Ther 2018;50(3):215-20.
32. White L, Reardon D, Davis K, Velli G, Bright M. Anterior suprascapular nerve block versus interscalene brachial plexus block for arthroscopic shoulder surgery: A systematic review and meta-analysis of randomized controlled trials. J Anesth 2022;36(1):17-25.
33. Brull R, McCartney CJ, Chan VWS, El-Beheiry H. Neurological complications after regional anesthesia: Contemporary estimates of risk. Anesth Analg 2007;104(4):965-74.