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Aaron Berg, D.O
University of Minnesota, USA
Posters & Accepted Abstracts: Gen Surg: Open Access
Background: Interscalene blocks provide analgesia for shoulder surgery but also cause phrenic nerve paralysis. Liposomal bupivacaine is approved for use in interscalene blocks with the potential to provide longer pain control. However, the impact of liposomal bupivacaine on the phrenic nerve has not been evaluated. It was hypothesized that patients who received an interscalene block with the addition of liposomal bupivacaine would have a decreased diaphragmatic excursion at 24h. Methods: This was a double-blinded study of adult patients who were randomized to receive an interscalene block either with 20 ml 0.5% bupivacaine (bupivacaine group) or 10 ml 0.5% bupivacaine plus 10 ml liposomal bupivacaine. Twenty-six patients were randomized with 22 included in the analysis. Diaphragmatic excursion (via ultrasound) and spirometry were assessed before the block, in PACU, and at 24 h. The primary outcome was diaphragm excursion with sigh. Results: At 24 h, the liposomal bupivacaine group median [25th, 75th], had a greater percent change in diaphragmatic excursion during sigh breath compared to the bupivacaine group, –24% [–30, –9] versus 9% [–8, 26], difference in location, 32 (95% CI, 12 to 52), P = 0.007. Five patients in the liposomal bupivacaine group had a greater than 25% reduction in diaphragmatic excursion at 24 h versus zero in the bupivacaine group. They also had a significantly greater percent reduction in FEV1 and FVC compared with the bupivacaine group at 24 h (median decrease of 22% vs. 2%, P = 0.006, and median decrease of 19% vs. 1%, P = 0.049, respectively). Conclusions: The addition of liposomal bupivacaine to bupivacaine in an interscalene block results in statistically significant reductions in diaphragm excursion and pulmonary function testing 24 h after block placement when compared to bupivacaine alone. This reduction, however, falls within the range of normal diaphragmatic function. Recent Publications: 1. Sommer, M.*; de Rijke, J. M.*; van Kleef, M.*; Kessels, A. G. H.†; Peters, M. L.¶; Geurts, J. W. J. M.*; Gramke, H.- F.*; Marcus, M. A. E.* The prevalence of postoperative pain in a sample of 1490 surgical inpatients, European Journal of Anaesthesiology: April 2008 - Volume 25 - Issue 4 - p 267-274 doi: 10.1017/S0265021507003031 2. Salviz EA, Xu D, Frulla A, Kwofie K, Shastri U, Chen J, Shariat AN, Littwin S, Lin E, Choi J, Hobeika P, Hadzic A: Continuous Interscalene Block in Patients Having Outpatient Rotator Cuff Repair Surgery: A Prospective Randomized Trial. Anesth Analg 2013; 117:1485-1492 3. Ilfeld, Brian M. MD, MS Continuous Peripheral Nerve Blocks, Anesthesia & Analgesia: October 2011 - Volume 113 - Issue 4 - p 904-925 doi: 10.1213/ANE.0b013e3182285e01 4. Marhofer D, Marhofer P, Triffterer L, Leonhardt M, Weber M, Zeitlinger M. Dislocation rates of perineural catheters: a volunteer study. Br J Anaesth. 2013 Nov;111(5):800-6. doi: 10.1093/bja/aet198. Epub 2013 Jun 7. PMID: 23748198. 5. Vandepitte C, Kuroda M, Witvrouw R, Anne L, Bellemans J, Corten K, Vanelderen P, Mesotten D, Leunen I, Heylen M, Van Boxstael S, Golebiewski M, Van de Velde M, Knezevic NN, Hadzic A. Addition of Liposome Bupivacaine to Bupivacaine HCl Versus Bupivacaine HCl Alone for Interscalene Brachial Plexus Block in Patients Having Major Shoulder Surgery. Reg Anesth Pain Med. 2017 May/Jun;42(3):334-341. doi: 10.1097/AAP.0000000000000560. PMID: 28157791
