Comparison of anterior suprascapular nerve block versus interscalane nerve block in terms of diaphragm paralysis in arthroscopic shoulder surgery: a prospective randomized clinical study.

OBJECTIVE: This prospective, randomized study aimed to compare anterior suprascapular nerve block versus interscalene block in terms of diaphragm paralysis in arthroscopic shoulder surgery. METHODS: Fifty-two patients undergoing shoulder arthroscopy surgery were prospectively randomly assigned to interscalene block (n=25) or anterior suprascapular nerve block groups (n=27) (each group receiving 5 mL, 0.5% bupivacaine). The ipsilateral diaphrag matic excursion was assessed in all patients using ultrasound imaging before (baseline), 30 minutes, and 24 hours after block completion. Pain scores were recorded 1 hour preoperative, 30-60 minutes in the postoperative recovery unit, and at 6 and 24 hours postoperatively. RESULTS: No complete paralysis was observed in either treatment group. The incidence of a partial decrease in diaphragm movements was significantly lower in the anterior suprascapular nerve block than in the interscalene block group (1 vs. 21 patients) (P < .01). Twenty-six patients in the anterior suprascapular nerve block and 4 in the interscalene block group had less than a 25% decrease in hemidiaphrag matic movements, 30 minutes after the blockade. Pain scores were similar in the 2 groups. However, mean pain scores at 24 hours post operatively were significantly higher in the interscalene block than in the anterior suprascapular nerve block group (P < .05). Time to first pain post-block was significantly longer in the anterior suprascapular nerve block compared to the interscalene block group (677.04 ± 52.17 minutes vs. 479.2 ± 99.74 minutes, P < .05). CONCLUSION: Anterior suprascapular nerve block and interscalene block both appear to be clinically effective in providing postoperative analgesia for patients undergoing arthroscopic shoulder surgery under general anesthesia. However, the time to first pain is significantly longer with anterior suprascapular nerve block. Pain scores at 24 hours postoperatively were significantly lower in the anterior supra scapular nerve block compared to the interscalene block group. Diaphragmatic movements after anterior suprascapular nerve block were also better preserved at both 30 minutes after the block and 24 hours after surgery. LEVEL OF EVIDENCE: Level I, Therapeutic Study.

Can Postoperative Pain Be Prevented in Bariatric Surgery? Efficacy and Usability of Fascial Plane Blocks: a Retrospective Clinical Study.

BACKGROUND: Providing analgesia after bariatric surgery might be challenging due to a high prevalence of obstructive sleep apnea syndrome and the increased sensitivity to respiratory depression triggered by opioid overuse after surgery. Various combination methods with paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and other pain medications such as ketamine or gabapentin have been suggested for reduction of the opioid usage. Regional anesthetic techniques represent a valuable option as they improve patient comfort while reducing opioid-related side effects. In this study, we have evaluated the adjuvant benefits of these various techniques in reduction of the postoperative pain in bariatric surgery. METHODS: After the approval of the IRB Ethics Committee, the records of the patients who had laparoscopic bariatric surgery between January 2019 and December 2021 were reviewed retrospectively. RESULTS: Records of 120 patients who underwent laparoscopic bariatric surgery between January 2019 and December 2021 were reviewed. In total, 113 patients with full documentation were included in this study. Among these, 74 patients were administered regional analgesia. The main regional analgesia techniques were transversus abdominis plane and rectus sheath block. The pain scores of those receiving regional analgesia were statistically low. The opioid consumption after transversus abdominis plane and rectus sheath block was significantly lower than that of others. External oblique intercostal block alone provides a postoperative opioid consumption similar to those of transversus abdominis plane and rectus sheath block. CONCLUSION: The use of fascial plane blocks in bariatric surgery significantly reduces opioid consumption. Transversus abdominis plane and rectus sheath block combination and external oblique intercostal block seem to be the most effective options. CLINICAL TRIALS NUMBER: NCT05284695.

Could Interscalene Block Possibly be Protective Against Cerebral Ischemia During Shoulder Surgery in a Beach Chair Position?

Introduction Arthroscopic shoulder surgeries are usually performed in a sitting position. The sitting position is known to cause physiological changes related to cardiovascular adaptation. Interscalene nerve blocks (ISB) are the most commonly used techniques and are considered gold standard regional anesthesia methods for shoulder surgeries. Cerebral vessels located around sympathetic ganglia provide sympathetic system integrity. This local anesthetic spreading during ISB could be a side effect or provide a protective effect on cerebral ischemia. Our study aimed to investigate the cerebral protective effect of the ISB in arthroscopic shoulder surgeries in a sitting position. Material and methods After the approval of Koç University Clinical Research Ethics Committee (2020.020.IRB1.011), records of patients between January and December 2019 with shoulder arthroscopy at the Vehbi Koç Foundation (VKV) American hospital were retrospectively reviewed. Records of the hemodynamic response, INVOSTM (Medtronic, Minneapolis, USA) (rSO2) parameters, pain scores, and additional analgesic needs of all cases were examined in the intraoperative and postoperative period. Results Data of 40 patients who met the criteria to be included in the study was analyzed. Our study showed that the sitting position leading to hypotension coincided with a decrease in INVOS values. Nevertheless, we did not record any significant hypotension after ISB, and this may be due to the use of a minimal dose of local anesthetic. There was a certain increase in near-infrared spectroscopy (NIRS) values ​​after ISB. We saw that the value of regional oxygen saturation (rSO2) increased on both the ISB side and the non-ISB side. This shows that the ISB can have a global impact on the brain. Specificially, the increase in rSO2 values ​​in the ISB side compared to the other side suggests that ISB has possible positive effects on cerebral blood flow. Conclusion Our study has shown that ISB may transiently increase the rSO2 levels in the sitting position during shoulder surgery.

Analgesic Effect of Dual Injection Technique for the Erector Spinae Plane Block in Beating Heart Coronary By-Pass Surgeries.

Introduction Various regional anesthesia techniques such as thoracic epidural, thoracic paravertebral block, erector spinae plane block (ESPB), parasternal intercostal blocks are used in cardiac surgery for postoperative analgesia. In our study, we investigated the analgesic efficacy of the dual injection technique of ESPB in beating heart coronary bypass surgeries. Methods The records of patients with coronary artery bypass (CABG) surgery in the beating heart at the VKV American Hospital between January and December 2019 were retrospectively analyzed. The data of 30 patients who met the criteria to be included in the study were analyzed. Whether any opioid use is required for maintenance of anesthesia it is recorded. The pain scores of the patients are recorded by the intensive care team and cardiovascular service nurses for the first 48 hours. Results The absence of secondary responses to pain in all surgical periods, including skin incision and sternotomy, and low number of rating scale (NRS) scores in the postoperative 0- to 24-hour period show that the technique we developed can produce effective analgesia. After the 24th postoperative hour, the patients were followed up in the cardiovascular service and there was no opioid use between 24- to 48-hour period. Conclusion Our approach, in which the local anesthetic is applied by approaching the superior costa-transverse ligament (SCTL) in the ESPB, provides an effective analgesia in coronary artery bypass surgeries in the beating heart. The main purpose of our new approach is to increase the amount of local anesthetic in the paravertebral area. We recommend using our modified technique for effective analgesia after CABG surgeries.

A comparison of continuous femoral nerve block and periarticular local infiltration analgesia in the management of early period pain developing after total knee arthroplasty.

OBJECTIVE: This study aimed to compare the effects of 24-h continuous femoral nerve block (CFNB) and periarticular infiltration analgesia (PIA) on postoperative pain and functional results in the first 6 weeks after total knee arthroplasty (TKA). METHODS: Sixty patients who underwent unilateral TKA were included in this study. The patients were divided into two groups: Group A received CFNB and Group B received PIA. Each patient received 0.25% levobupivacaine and 1:100,000 epinephrine as infiltration to the posterior capsule. A patient-controlled analgesia (PCA) device was used for all patients, and 24-h tramadol usage by patients was recorded. We measured maximum range of motion (ROM), pain using a visual analog scale (VAS), 2-min walk test (2MWT), and the scores of Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Knee Society Score (KSS). RESULTS: Compared with Group B, Group A had lower postoperative opioid usage (p<0.05), less pain at rest (p<0.05), less pain with passive motion (p<0.05), less pain with movement and after active movement (p<0.05), and superior passive and active ROM (p<0.05). Group A also had better 2MWT results at 24 and 48 h after surgery (p<0.05), and superior WOMAC and KSS results at 6 weeks after surgery. CONCLUSION: As long as it is applied with infiltration analgesia to the posterior capsule, CFNB is an effective and safe analgesia method resulting in better postoperative patient comfort and greater ROM. Furthermore, it produces better results in the early postoperative period with a favorable side effect profile.