Ultrasound-guided interscalene nerve block with an ultralow volume of local anesthetic for post-thoracotomy shoulder girdle pain

• Published in: Journal of cardiothoracic and vascular anesthesia
• Main Authors: Saranteas, Theodosios, MD, Alevizou, Anastasia, MD, Sidiropoulou, Tatiana, MD, Mavrogenis, Andreas, MD, Tomos, Periklis, MD, Florou, Panagiota, MD, Papadimos, Thomas, MD, Kostopanagiotou, Georgia, MD
• Format: Journal Article
• Language: English
• Published: 2017
• Subjects: Anesthesia & Perioperative Care; Critical Care; Interscalene brachial plexus nerve block; Shoulder; Thoracotomy
• ISSN: 1053-0770
• DOI: 10.1053/j.jvca.2017.04.043

Objectives To evaluate the efficacy of ultrasound-guided interscalene nerve block using an ultralow volume of local anaesthetic (5 ml ropivacaine 0.75%) for the management of post-thoracotomy shoulder girdle pain. Design Open cohort, prospective, single center study. Setting University hospital. Interventions Patients with post-thoracotomy shoulder girdle pain (visual analog scale, VAS ≥5) received an ultrasound-guided interscalene nerve block. Measurements and main Results Thirty minutes after block implementation the VAS was used to quantify the pain across the shoulder girdle. The index (I) was calculated to indicate improvement of pain as follows: I = VAS before interscalene nerve block–VAS after interscalene nerve block/VAS before interscalenenerve nerve block x 100. Nerve bocks resulting in (I) ≥75% were considered excellent. Total tramadol consumption 36h after nerve blocks, patients’ satisfaction, and complications related to the procedure were also assessed. Patients were segregated in two groups; Group A: patients with pain in the shoulder area (glenohumeral and acromioclavicular joints), (n=30) and Group B: patients with pain in the scapula, (n=17). The (I) index was significantly greater in Group A (88.3±14%) than in Group B, (43.2±22%). In groups A and B, 90% and 11% of patients, respectively, demonstrated excellent pain control. Total tramadol consumption in Group A, 25 (0-100) mg, was significantly less that of Group B, 250 (150-500) mg. Patients’ satisfaction was also significantly higher in Group A as compared to Group B. No complications were recorded. Conclusions Ultrasound-guided interscalene nerve block can substantially alleviate post-thoracotomy pain in the shoulder but not in the scapular area.