Single-shot versus slow infusion interscalene block and its impact on diaphragmatic function in patients undergoing shoulder surgery, a double blind randomized controlled trial - 06/03/26
, Basma Gamal, Lydia Magdy Milad, Akram El Adawy, Fatma Ibrahim, Sahar Mahmoud Mohamed Kasem, Hanan MostafaAbstract |
Background |
The Interscalene block offers adequate anesthesia and analgesia to the shoulder. Ipsilateral phrenic nerve paralysis is a common and generally well-tolerated consequence of the interscalene block. However, it may become clinically significant in patients with pre-existing respiratory conditions or limited pulmonary reserve. We hypothesized that a slow infusion of an interscalene block over 10 min would reduce the incidence of a complete phrenic nerve block.
Methods |
This randomized controlled trial included 83 patients who underwent arthroscopic shoulder surgery. Patients were randomly allocated into one of two groups: single shot ( n = 42), who received an interscalene block as a 10 mL 0.5% bupivacaine over 1 min, or slow infusion ( n = 41), who received 10 mL 0.5% bupivacaine over 10 min via an indwelling catheter using a syringe pump. An experienced operator examined the corresponding hemidiaphragm for diaphragmatic excursion at baseline and 10-minute intervals for 30 min after the interscalene block. The main outcome variable was the incidence of complete phrenic nerve block.
Results |
Eighty-three patients were included in the final analysis. Demographic data, including age, body mass index, sex, type, and duration of surgery, were not significantly different between the groups. The slow-infusion and single-shot groups showed 7% and 83% complete phrenic nerve block, respectively. Additionally, Forced Expiratory Volume at 1 s (FEV1) and Forced Vital Capacity (FVC) at 30 min after block administration were significantly lower in the single-shot group. Notably, 24 h resting NRS score and morphine consumption were comparable between the groups, indicating preserved 24 h postoperative analgesic efficacy.
Conclusion |
In adult patients undergoing arthroscopic shoulder surgery, slow infusion interscalene block reduced the incidence of complete phrenic nerve block to 7% compared to 83% in the single-shot block with comparable 24 h postoperative analgesic efficacy. Additionally, it preserved pulmonary function in terms of FEV1 and FVC without reducing analgesic efficacy compared with the single-shot approach.
Trial registration |
ClinicalTrials.gov ( NCT06820853 ).
Le texte complet de cet article est disponible en PDF.Keywords : Interscalene block, Single shot, Phrenic block, Diaphragmatic excursion, Slow infusion
Plan
| ☆ | This study was conducted at Cairo University Hospital, Cairo University, Egypt. |
Vol 45 - N° 4
Article 101668- juillet 2026 Retour au numéro
Article précédent
- Efficacy of Erector Spinae Plane Block in Preventing Chronic Pain After Breast Cancer Surgery: A Randomized Controlled Trial
- Wenjun Lin, Xiaohong Zhang, Yifen Zhuo, Sisi Chen, Ying Yang, Weitao Gao, Guisheng Ding, Yusheng Yao
- Rapid sequence intubation in high-risk patients: what clinicians and researchers must know – a narrative review
- Nancy M. Boulos, Patrick Schoettker, Amelie Delaporte, Yonathan Freund, Nicolas Grillot, Alexandre Joosten
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?