Achar FT, Fortis OLL, Cruz VJA, Yáñez AAA, Aguilera ZAM

Language: Spanish
References: 26
Page: 18-23
PDF size: 246.12 Kb.

ABSTRACT

Introduction: postoperative pain can be present in up to 80% of patients undergoing surgery, increasing morbidity and costs. Shoulder surgery is considered one of the procedures with the highest incidence of postoperative pain. The use of an immediate postoperative regional analgesia technique is associated with a decrease in postoperative complications. The purpose of this study was to compare the duration of analgesia between different drug mixtures used in ultrasound-guided interscalene block performed in the immediate postoperative period of shoulder arthroscopies due to rotator cuff pathology. Material and methods: Prospective, longitudinal, comparative, and experimental clinical trial. Thirty patients were scheduled for shoulder arthroscopy with rotator cuff repair, and ASA I and II were included. They were distributed into three groups, each consisting of 10 patients, according to the mixture used in the interscalene block: A) ropivacaine, lidocaine, clonidine, and dexamethasone; B) ropivacaine, lidocaine, and dexamethasone; and C) ropivacaine, lidocaine, and clonidine. The collected data included vital signs, pain intensity, adverse events, and rescue medication. Results: No statistically significant differences were observed between the three groups throughout the postoperative period. Conclusions: Based on the results, we can recommend any of the three mixtures used in this study as postoperative analgesia in shoulder arthroscopy in well-selected patients.

REFERENCES

1. Fortis-Olmedo LL, Ortega-Ponce FEE, Torres-Gómez A, Pineda-Rivera A, Chávez-Ramírez MA. Eficacia de la pregabalina para disminución del dolor postoperatorio en reparación de ligamento cruzado anterior. Rev Mex Anestesiol. 2019; 42 (4): 247-253.

2. Mejía-Terrazas G, Zaragoza-Lemus G. Anestesia para cirugía de hombro. Rev Mex Anestesiol. 2011; 34 (2): 91-102.

3. de Boer FA, Schouten TTJ, Boekestein EP, van Eijk F, van Kampen PM, Bazuin R et al. Risk factors for postoperative pain in the first three weeks after arthroscopic or open shoulder surgery. Orthop Traumatol Surg Res. 2019; 105 (2): 241-244.

4. Sulaiman L, Macfarlane RJ, Waseem M. Current concepts in anaesthesia for shoulder surgery. Open Orthop J. 2013; 7 (3): 323-328.

5. Singelyn FJ, Lhotel L, Fabre B. Pain relief after arthroscopic shoulder surgery: a comparison of intraarticular analgesia, suprascapularnerve block, and interscalene brachial plexus block. Anesth Analg. 2004; 99 (2): 589-592.

6. Waleed A. Postoperative analgesia for arthroscopic shoulder surgery: comparison between ultrasound-guided interscalene block and combined suprascapular and axillary nerve blocks. Ain-Shams J Anaesthesiol. 2016; 9 (4): 536-541.

7. Galván-Talamantes Y, Álvarez-Reséndiz GE, Cisneros-García J, López-Hernández MN, Fernández-Soto JR, Fajardo-Pérez M. Manejo analgésico postoperatorio con bloqueos regionales guiados por ultrasonografía en cirugía de hombro. An Med (Mex). 2020; 65 (2): 114-121.

8. Ullah H, Samad K, Khan FA. Continuous interscalene brachial plexus block versus parenteral analgesia for postoperative pain relief after major shoulder surgery. Cochrane Database Sys Rev. 2014; 2014 (2): CD007080.

9. Hewson DW, Oldman M, Bedforth NM. Regional anaesthesia for shoulder surgery. BJA Educ. 2019; 19 (4): 98-104.

10. Gohl MR, Moeller RK, Olson RL, Vacchiano CA. The addition of interscalene block to general anesthesia for patients undergoing open shoulder procedures. AANA Journal. 2001; 69 (2): 105-109.

11. Bosco L, Zhou C, Murdoch JAC, Bicknell R, Hopman WM, Phelan R et al. Pre- or postoperative interscalene block and/or general anesthesia for arthroscopic shoulder surgery: a retrospective observational study. Can J Anesth. 2017; 64 (10): 1048-1058.

12. Mejía-Terrazas GE, Ruiz-Suarez M, Gaspar-Carrillo SP, Valero-González F, Unzueta-Navarro D, Encalada-Díaz I. Bloqueo interescalénico para artroplastia total de hombro: estudio comparativo ultrasonido vs neuroestimulación. Cir Cir. 2014; 82 (4): 381-388.

13. Stasiowski MJ, Kolny M, Zuber M, Marciniak R, Chabierska E, Jalowiecki P et al. Randomised controlled trial of analgesic effectiveness of three different techniques of single-shot interscalene brachial plexus block using 20 mL of 0.5% ropivacaine for shoulder arthroscopy. Anaesthesiol Intensive Ther. 2017; 49 (3): 215-221.

14. Kim D, Beathe J, Wetmore D, Haskins S, Oxendine J, Allen A et al. Interscalene brachial plexus block with liposomal bupivacaine versus standard bupivacaine with perineural dexamethasone: a noninferiority trial. Anesthesiology. 2022; 136 (3): 434-481.

15. Casati A, Fanelli G, Aldegheri G, Berti M, Colnaghi E, Cedrati V et al. Interscalene brachial plexus anaesthesia with 0.5%, 0.75% or 1% ropivacaine: a double-blind comparison with 2% mepivacaine. Br J Anaesth. 1999; 83 (6): 872-877.

16. Deganutti L, Carrizo R, Astore F, Narbona P. Eficacia de la dexametasona como coadyuvante en BLOQUEO interescalénico. Artroscopia. 2012; 19 (4): 161-167.

17. Velázquez-Delgado E, Gaspar-Carrillo S, Pena-Riveron A, Mejia-Terrazas G. Postoperative analgesia with dexmedetomidine in interscalene block. Comparative study. Rev Esp Anestesiol Reanim. 2017; 64 (3): 137-143.

18. Sun Z, Wang B, Niu Z, Shan S. Dexmedetomidine improves continuous interscalene brachial plexus block in patients after arthroscopic rotator cuff repair. Int J Clin Exp Med. 2018; 11 (4): 4168-4172.

19. Elbahrawy K, El-Deeb A. Dexamethasone versus ketamine in the interscalene block in patients undergoing arthroscopic shoulder surgery: a randomized double-blinded study. Asian J Anesthesiol. 2018; 56 (4): 136-142.

20. Vasconcelos MM, Pontes JPJ, Rodrigues A de M, Neto DR de B, Alves RR, Silva FC do P et al. Perineural dexamethasone in ultrasound-guided interscalene brachial plexus block with levobupivacaine for shoulder arthroscopic surgery in the outpatient setting: randomized controlled trial. Rev Bras Anestesiol. 2020; 70 (6): 588-594.

21. Cummings III K, Napierkowski D, Parra-Sanchez I. Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine. Br J Anaesth. 2011; 107 (3): 446-455.

22. Chen HP, Shen SJ, Tsai HI, Kao SC, Yu HP. Effects of interscalene nerve block for postoperative pain management in patients after shoulder surgery. Biomed Res Int. 2015; 2015: 1-5.

23. Beecroft CL, Coventry DM. Anaesthesia for shoulder surgery. Contin Educ Anaesth Crit Care Pain. 2008; 8 (6): 193-198.

24. Segura-Grau E, Reinoso-Barbero F. Bloqueo interescalénico ecoguiado: ventajas en pediatría. Rev Soc Esp Dolor. 2009; 16 (1): 29-31.

25. Bruce BG, Green A, Blaine TA, Wesner LV. Brachial plexus blocks for upper extremity orthopaedic surgery. J Am Acad Orthop Surg. 2012; 20 (1): 38-47.

26. Badran MA el FM, Kamaly AM, Abdel-Hamid HM, Mostafa RH. Dexamethasone as a bupivacaine adjuvant for ultrasound-guided interscalene brachial plexus block: a prospective randomized study. Ain-Shams J Anesthesiol. 2020; 12 (61): 1-10.