Diaphragm-sparing nerve blocks for shoulder surgery, revisited
Journal
Regional Anesthesia & Pain Medicine
ISSN
1098-7339
1532-8651
Date Issued
2020
Author(s)
De Q Tran
Sebastián Layera
Daniela Bravo
Iver Cristi-Sanchéz
Loreley Bermudéz
Julián Aliste
Type
Resource Types::text::journal::journal article
Abstract
<jats:p>Although interscalene brachial plexus block (ISB) remains the gold standard for analgesia after shoulder surgery, the inherent risks of ipsilateral phrenic nerve block and hemidiaphragmatic paralysis (HDP) limit its use in patients with preexisting pulmonary compromise. In a previous Daring Discourse (2017), our research team has identified potential diaphragm-sparing alternatives to ISB for patients undergoing shoulder surgery. In recent years, the field has been fertile with research, with the publication of multiple randomized controlled trials investigating supraclavicular blocks, upper trunk blocks, anterior suprascapular nerve blocks, costoclavicular blocks, and combined infraclavicular-suprascapular blocks. To date, the cumulative evidence (pre-2017 and post-2017) suggests that costoclavicular blocks may provide similar postoperative analgesia to ISB coupled with a 0%-incidence of HDP. However, in light of the small number of patients recruited by the single study investigating costoclavicular blocks, further confirmatory trials are required. Moreover, future investigation should also be undertaken to determine if costoclavicular blocks could achieve surgical anesthesia for shoulder surgery. Anterior suprascapular nerve blocks have been demonstrated to provide surgical anesthesia and similar analgesia to ISB. However, their risk of HDP has not been formally quantified. Of the remaining diaphragm-sparing nerve blocks, supraclavicular blocks (with local anesthetic injection posterolateral to the brachial plexus), upper trunk blocks, and combined infraclavicular-anterior suprascapular blocks merit further investigation, as they have been shown to achieve similar analgesia to ISB, coupled with an HDP incidence <10%.</jats:p>
Subjects
brachial-plexus block
;
ultrasound-guided interscalene
;
suprascapular nerve
;
hemidiaphragmatic paresis
;
postoperative analgesia
;
double-blind
;
costoclavicular space
;
pulmonary-function
;
phrenic-nerve
;
volume
;
article
;
brachial plexus anesthesia
;
diaphragm
;
human
;
nerve block
;
nerve root
;
phrenic nerve
;
postoperative analgesia
;
priority journal
;
randomized controlled trial (topic)
;
regional anesthesia
;
shoulder surgery