Effect of brachial plexus block on the incidence of arterial hypotension and bradycardia events during shoulder arthroscopy in adolescents

Abstract

Background. The role and significance of the technical aspects of interscalene brachial plexus block in the occurrence of sudden arterial hypotension and bradycardia events during shoulder arthroscopy in a semi-sitting position are ambiguous.

Aim. The study aimed to assess the effect of interscalene brachial plexus block on the incidence of hypotension-bradycardia events during shoulder arthroscopic surgery in adolescents in a semi-sitting position.

Materials and methods. This retrospective analysis of anesthesia protocols included 288 patients who underwent arthroscopic shoulder surgery in a semi-sitting position under the interscalene brachial plexus block. Regional blockades were performed with neurostimulation in Group 1 (n = 23), neurostimulation and ultrasound navigation without repositioning the needle in Group 2 (n = 70), and neurostimulation and ultrasound navigation with multiple precision repositioning the needle in Group 3 (n = 195).

Results. Hypotension-bradycardia events were detected in 26 patients out of 288 (9%). There was a statistically significant difference in the frequency of hypotension-bradycardia in all groups: 10 (43.48%) in Group 1, 15 (21.43%) in Group 2, and 1 (0.51%) in Group 3 (p = 0.000). A direct correlation between hypotension-bradycardia episodes and local anesthetic volume (r = 0.405; p < 0.05), and Horner’s syndrome (r = 0.684, p < 0.05) was found.

Conclusions. Interscalene brachial plexus block with a target delivery of low volume of local anesthetic and dual navigation reduces the risk of hypotension-bradycardia. Horner’s syndrome can be considered an early predictor of hypotension-bradycardia events.

Keywords

hypotension-bradycardia events / interscalene brachial plexus block / arthroscopic shoulder surgery / Horner’s syndrome

References

[1] Kahn RL, Hargett MJ. Beta-adrenergic blockers and vasovagal episodes during shoulder surgery in the sitting position under interscalene block. Anesth Analg Analgesia. 1999;88(2):378-381. https://doi.org/10.1097/00000539-199902000-00029.

[2] Chierichini A, Frassanito L, Vergari A, et al. The effect of norepinephrine versus epinephrine in irrigation fluid on the incidence of hypotensive/bradycardic events during arthroscopic rotator cuff repair with interscalene block in the sitting position. Arthroscopy. 2015;31(5):800-806. https://doi.org/10.1016/j.arthro. 2015.02.030.

[3] Kim JH, Song SY, Ryu T, et al. Changes in heart rate variability after sitting following interscalene block. Clin Auton Res. 2015;25(5):327-333. https://doi.org/10.1007/s10286-015-0312-z.

[4] Tetzlaff JE. Cousins and Bridenbaugh’s neural blockade in clinical anesthesia and pain medicine. Mayo Clin Proc. 2010;85(7):e51. https://doi.org/10.4065/mcp.2010.0230.

[5] Song SY, Roh WS. Hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene brachial plexus blocks. Korean J Anesthesiol. 2012;62(3):209. https://doi.org/10.4097/kjae.2012.62.3.209.

[6] Seo KC, Park JS, Roh WS. Factors contributing to episodes of bradycardia hypotension during shoulder arthroscopic surgery in the sitting position after interscalene block. Korean J Anesthesiol. 2010;58(1):38-44. https://doi.org/10.4097/kjae.2010.58.1.38.

[7] Song SY, Son SH, Kim SO, Roh WS. Intravenous fentanyl during shoulder arthroscopic surgery in the sitting position after interscalene block increases the incidence of episodes of bradycardia hypotension. Korean J Anesthesiol. 2011;60(5):344-350. https://doi.org/10.4097/kjae.2011.60.5.344.

[8] D’Alessio JG, Weller RS, Rosenblum M. Activation of the Bezold-Jarisch reflex in the sitting position for shoulder arthroscopy using interscalene block. Anesth Analg. 1995;80(6):1158-1162. https://doi.org/10.1097/00000539-199506000-00016.

[9] Sia S, Sarro F, Lepri A, Bartoli M. The effect of exogenous epinephrine on the incidence of hypotensive/bradycardic events during shoulder surgery in the sitting position during interscalene block. Anesth Analg. 2003;97(2):583-588, table of contents. https://doi.org/10.1213/01.ane.0000070232.06352.48.

[10] Liguori GA, Kahn RL, Gordon J, et al. The use of metoprolol and glycopyrrolate to prevent hypotensive/bradycardic events during shoulder arthroscopy in the sitting position under interscalene block. Anesth Analg. 1998;87(6):1320-1325. https://doi.org/10.1213/00000539-199812000-00020.

[11] Nallam SR, Dara S. Effect of intravenous ondansetron on reducing the incidence of hypotension and bradycardia events during shoulder arthroscopy in sitting position under interscalene brachial plexus block: A prospective randomized trial. Indian J Anaesth. 2015;59(6):353-358. https://doi.org/10.4103/0019-5049.158739.

[12] Conroy PH, Awad IT. Ultrasound-guided blocks for shoulder surgery. Curr Opin Anaesthesiol. 2011;24(6):638-643. https://doi.org/10.1097/ACO. 0b013e32834c155f.

[13] Gautier P, Vandepitte C, Ramquet C, et al. The minimum effective anesthetic volume of 0.75% ropivacaine in ultrasound-guided interscalene brachial plexus block. Anesth Analg. 2011;113(4):951-955. https://doi.org/10.1213/ANE.0b013e31822b876f.

[14] Майер Г., Бюттнер Й. Периферическая регионарная анестезия: атлас / под ред. П.Р. Камчатнова. – М.: БИНОМ. Лаборатория знаний, 2010. – 260 с. [Mayer G, Byuttner J. Perifericheskaya regionarnaya anesteziya: atlas. Ed. by P.R. Kamchatnov. Moscow: BINOM. Laboratoriya znaniy; 2010. 260 p. (In Russ.)]

[15] Патент РФ на изобретение № 2610883/17.02.2017. Бюл. № 5. Трухин К.С., Кулешов О.В., Заболотский Д.В., и др. Способ межлестничной анестезии при артроскопических оперативных вмешательствах на плечевом суставе. [Patent RUS No. 2610883/17.02.2017. Byul. No. 5. Trukhin KS, Kuleshov OV, Zabolotskiy DV, et al. Sposob mezhlestnichnoy anestezii pri artroskopicheskikh operativnykh vmeshatel’stvakh na plechevom sustave. (In Russ.)]

[16] Simeoforidou M, Vretzakis G, Chantzi E, et al. Effect of interscalene brachial plexus block on heart rate variability. Korean J Anesthesiol. 2013;64(5):432-438. https://doi.org/10.4097/kjae.2013.64.5.432.

[17] Sukhani R, Barclay J, Aasen M. Prolonged Horner’s syndrome after interscalene block: a management dilemma. Anesth Analg. 1994;79(3):601-603. https://doi.org/10.1213/00000539-199409000-00038.

[18] Maalouf DB, Dorman SM, Sebeo J, et al. Prospective, randomized double-blind study: does decreasing interscalene nerve block volume for surgical anesthesia in ambulatory shoulder surgery offer same-day patient recovery advantages? Reg Anesth Pain Med. 2016;41(4):438-444. https://doi.org/10.1097/AAP.0000000000000418.

[19] Feigl G, Fuchs A, Gries M, et al. A supraomohyoidal plexus block designed to avoid complications. Surg Radiol Anat. 2006;28(4):403-408. https://doi.org/10.1007/s00276-006-0113-0.

[20] Kim BG, Han JU, Song JH, et al. A comparison of ultrasound-guided interscalene and supraclavicular blocks for post-operative analgesia after shoulder surgery. Acta Anaesthesiol Scand. 2017;61(4):427-435. https://doi.org/10.1111/aas.12864.

[21] 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):215-220. https://doi.org/10.5603/AIT.a2018.0013.

[22] Fredrickson MJ, Abeysekera A, White R. Randomized study of the effect of local anesthetic volume and concentration on the duration of peripheral nerve blockade. Reg Anesth Pain Med. 2012;37(5):495-501. https://doi.org/10.1097/AAP.0b013e3182580fd0.

RIGHTS & PERMISSIONS

Trukhin K.S., Zabolotskii D.V., Koriachkin V.A., Kuleshov O.V., Zakharov K.I., Сherednichenko A.A., Kulikov A.Y.