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Anaesth Crit Care Pain Med. 2016 Dec;35(6):383-390. doi: 10.1016/j.accpm.2016.01.009. Epub 2016 Jun 18.

Continuous interscalene brachial plexus nerve block prolongs unilateral diaphragmatic dysfunction.

Author information

1
Department of Anaesthesiology and Pain Management, Centre Hospitalo-Universitaire (CHU) Carémeau, Nîmes, France; Université Montpellier 1, Montpellier, France. Electronic address: philippe.cuvillon@chu-nimes.fr.
2
Department of Anaesthesiology and Critical Care, Centre Hospitalo-Universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
3
Department of Biostatistics, Epidemiology, Public Health and Medical Information (BESPIM), University Hospital, Nîmes, France.
4
Department of Anaesthesiology and Pain Management, Centre Hospitalo-Universitaire (CHU) Carémeau, Nîmes, France; Université Montpellier 1, Montpellier, France.
5
AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles-Foix, Department of Emergency Medicine and Surgery, 75013 Paris, France; Sorbonne Universités, UPMC Université Paris 06, 75005 Paris, France.
6
Sorbonne Universités, UPMC Université Paris 06, 75005 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles-Foix, Department of Anaesthesiology and Critical Care, 75013 Paris, France.
7
AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles-Foix, Department of Anaesthesiology and Critical Care, 75013 Paris, France; Inserm, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, 75005 Paris, France; Sorbonne Universités, UPMC Université Paris 06, UMR-S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, 75005 Paris, France.

Abstract

BACKGROUND AND OBJECTIVES:

Single interscalene blocks (ISB) impair pulmonary function (<24h). 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 12h until h48. ISBs were performed with 15mL 0.5% ropivacaine using an ultrasound technique approach. The continuous group received the same bolus followed by 0.2% ropivacaine 5mL·h-1 (48h). The primary end point was the reduction (> 25% from baseline) of forced vital capacity (FVC) over the study period (48h).

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.

KEYWORDS:

Anaesthetic techniques; Anaesthetics techniques; Continuous interscalene; Evaluation; Regional; Spirometry

PMID:
27329990
DOI:
10.1016/j.accpm.2016.01.009
[Indexed for MEDLINE]

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