Neurologic Outcomes After Low-Volume, Ultrasound-Guided Interscalene Block and Ambulatory Shoulder Surgery

BACKGROUND AND OBJECTIVESPostoperative neurologic symptoms after interscalene block and shoulder surgery have been reported to be relatively frequent. Reports of such symptoms after ultrasound-guided block have been variable. We evaluated 300 patients for neurologic symptoms after low-volume, ultras...

Full description

Saved in:

Bibliographic Details
Published in:	Regional anesthesia and pain medicine Vol. 41; no. 4; pp. 477 - 481
Main Authors:	Rajpal, Gaurav, Winger, Daniel G, Cortazzo, Megan, Kentor, Michael L, Orebaugh, Steven L
Format:	Journal Article
Language:	English
Published:	England Copyright by American Society of Regional Anesthesia and Pain Medicine 01-07-2016 BMJ Publishing Group LTD
Subjects:	Adult Aged Ambulatory Surgical Procedures - adverse effects Ambulatory Surgical Procedures - methods Anesthetics, Combined - administration & dosage Anesthetics, Combined - adverse effects Anesthetics, Local - administration & dosage Anesthetics, Local - adverse effects Arthroscopy - adverse effects Bupivacaine - administration & dosage Bupivacaine - adverse effects Electric Stimulation Female Humans Ketamine Male Mepivacaine - administration & dosage Mepivacaine - adverse effects Middle Aged Nerve Block - adverse effects Nerve Block - methods Neurologic Examination - methods Peripheral Nervous System Diseases - diagnosis Peripheral Nervous System Diseases - etiology Peripheral Nervous System Diseases - physiopathology Prospective Studies Regional anesthesia Shoulder Shoulder - innervation Shoulder - surgery Surgery Time Factors Treatment Outcome Ultrasonic imaging Ultrasonography, Interventional
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	BACKGROUND AND OBJECTIVESPostoperative neurologic symptoms after interscalene block and shoulder surgery have been reported to be relatively frequent. Reports of such symptoms after ultrasound-guided block have been variable. We evaluated 300 patients for neurologic symptoms after low-volume, ultrasound-guided interscalene block and arthroscopic shoulder surgery. METHODSPatients underwent ultrasound-guided interscalene block with 16 to 20 mL of 0.5% bupivacaine or a mix of 0.2% bupivacaine/1.2% mepivacaine solution, followed by propofol/ketamine sedation for ambulatory arthroscopic shoulder surgery. Patients were called at 10 days for evaluation of neurologic symptoms, and those with persistent symptoms were called again at 30 days, at which point neurologic evaluation was initiated. Details of patient demographics and block characteristics were collected to assess any association with persistent neurologic symptoms. RESULTSSix of 300 patients reported symptoms at 10 days (2%), with one of these patients having persistent symptoms at 30 days (0.3%). This was significantly lower than rates of neurologic symptoms reported in preultrasound investigations with focused neurologic follow-up and similar to other studies performed in the ultrasound era. There was a modest correlation between the number of needle redirections during the block procedure and the presence of postoperative neurologic symptoms. CONCLUSIONSUltrasound guidance of interscalene block with 16- to 20-mL volumes of local anesthetic solution results in a lower frequency of postoperative neurologic symptoms at 10 and 30 days as compared with investigations in the preultrasound period.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23
ISSN:	1098-7339 1532-8651
DOI:	10.1097/AAP.0000000000000425