Anaesthesia, critical care & pain medicine · 2025
Single-shot versus slow infusion interscalene block and its impact on diaphragmatic function in patients undergoing shoulder surgery, a double blind randomized controlled trial.
СтатьяРандомизированное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Helmy Mina Adolf, Gamal Basma, Milad Lydia Magdy, El Adawy Akram, Ibrahim Fatma, Kasem Sahar Mahmoud Mohamed, Mostafa Hanan
Аннотация
BACKGROUND: The Interscalene block offers adequate anesthesia and analgesia to the shoulder. Ipsilateral phrenic nerve paralysis is a common and generally well-tolerated consequence of the interscalene block. However, it may become clinically significant in patients with pre-existing respiratory conditions or limited pulmonary reserve. We hypothesized that a slow infusion of an interscalene block over 10 min would reduce the incidence of a complete phrenic nerve block.
METHODS: This randomized controlled trial included 83 patients who underwent arthroscopic shoulder surgery. Patients were randomly allocated into one of two groups: single shot (n = 42), who received an interscalene block as a 10 mL 0.5% bupivacaine over 1 min, or slow infusion (n = 41), who received 10 mL 0.5% bupivacaine over 10 min via an indwelling catheter using a syringe pump. An experienced operator examined the corresponding hemidiaphragm for diaphragmatic excursion at baseline and 10-minute intervals for 30 min after the interscalene block. The main outcome variable was the incidence of complete phrenic nerve block.
RESULTS: Eighty-three patients were included in the final analysis. Demographic data, including age, body mass index, sex, type, and duration of surgery, were not significantly different between the groups. The slow-infusion and single-shot groups showed 7% and 83% complete phrenic nerve block, respectively. Additionally, Forced Expiratory Volume at 1 s (FEV1) and Forced Vital Capacity (FVC) at 30 min after block administration were significantly lower in the single-shot group. Notably, 24 h resting NRS score and morphine consumption were comparable between the groups, indicating preserved 24 h postoperative analgesic efficacy.
CONCLUSION: In adult patients undergoing arthroscopic shoulder surgery, slow infusion interscalene block reduced the incidence of complete phrenic nerve block to 7% compared to 83% in the single-shot block with comparable 24 h postoperative analgesic efficacy. Additionally, it preserved pulmonary function in terms of FEV1 and FVC without reducing analgesic efficacy compared with the single-shot approach.
TRIAL REGISTRATION: ClinicalTrials.gov (NCT06820853).
METHODS: This randomized controlled trial included 83 patients who underwent arthroscopic shoulder surgery. Patients were randomly allocated into one of two groups: single shot (n = 42), who received an interscalene block as a 10 mL 0.5% bupivacaine over 1 min, or slow infusion (n = 41), who received 10 mL 0.5% bupivacaine over 10 min via an indwelling catheter using a syringe pump. An experienced operator examined the corresponding hemidiaphragm for diaphragmatic excursion at baseline and 10-minute intervals for 30 min after the interscalene block. The main outcome variable was the incidence of complete phrenic nerve block.
RESULTS: Eighty-three patients were included in the final analysis. Demographic data, including age, body mass index, sex, type, and duration of surgery, were not significantly different between the groups. The slow-infusion and single-shot groups showed 7% and 83% complete phrenic nerve block, respectively. Additionally, Forced Expiratory Volume at 1 s (FEV1) and Forced Vital Capacity (FVC) at 30 min after block administration were significantly lower in the single-shot group. Notably, 24 h resting NRS score and morphine consumption were comparable between the groups, indicating preserved 24 h postoperative analgesic efficacy.
CONCLUSION: In adult patients undergoing arthroscopic shoulder surgery, slow infusion interscalene block reduced the incidence of complete phrenic nerve block to 7% compared to 83% in the single-shot block with comparable 24 h postoperative analgesic efficacy. Additionally, it preserved pulmonary function in terms of FEV1 and FVC without reducing analgesic efficacy compared with the single-shot approach.
TRIAL REGISTRATION: ClinicalTrials.gov (NCT06820853).