Interscalene brachial plexus block (ISB) constitutes the analgesic criterion standard for shoulder surgery. However, it is associated with a high incidence of hemidiaphragmatic paralysis (HDP) that may not be tolerated by patients with chronic pulmonary disease. Continuous ISBs have not avoided this complication with the reported and regularly used local anesthetic dilutions (i.e. 0.125% bupivacaine, 0.25% ropivacaine, etc). This observational study will register the incidence of HDP in continuous interscalene block (CISB) using a very diluted solution of levobupivacaine (0.04%) in patients undergoing arthroscopic shoulder surgery. The main objective of this study is to determine the frequency of HDP the first postoperative day before patient discharge(POD).
Study Type
OBSERVATIONAL
Enrollment
30
Clínica Las Condes
Santiago, Metropolitan, Chile
Hemidiaphragmatic paralysis before discharge
Defined as less than 25% of basal diaphragm excursion evaluated with ultrasonography
Time frame: 24 hours after surgery
Hemidiaphragmatic paralysis after surgery
Defined as less than 25% of basal diaphragm excursion evaluated with ultrasonography
Time frame: 30 minutes after arrival to post anesthetic care unit (PACU)
Amount of local anesthetic (LA) boluses used before discharge.
boluses of LA administered by the patient controlled infusor in adidiotn to a basal rate.
Time frame: 24 hours after surgery
Level of static postoperative pain at 30 minutes of arrival to PACU
level of pain at rest referred by the patient using a numeric rating scale from 0 to 10
Time frame: 30 minutes after arrival to PACU
Level of static postoperative pain 1 hour after arrival to PACU
level of pain at rest referred by the patient using a numeric rating scale from 0 to 10
Time frame: 60 minutes after arrival
Level of static postoperative pain 3 hour after arrival to PACU
level of pain at rest referred by the patient using a numeric rating scale from 0 to 10
Time frame: 3 hours after arrival to PACU
level of static pain 6 hours after arrival to PACU
level of pain at rest referred by the patient using a numeric rating scale from 0 to 10
Time frame: 6 hours after arrival to PACU
Level of static pain 12 hours after arrival to PACU
Level of pain at rest referred by the patient using a numeric rating scale from 0 to 10
Time frame: 12 hour after arrival to PACU
Level of static pain before discharge
Level of pain at rest referred by the patient using a numeric rating scale from 0 to 10
Time frame: 24 hours post surgery
Level of static pain during first day after the day of discharge
Level of pain at rest referred by the patient using a numeric rating scale from 0 to 10
Time frame: 48 hours after surgery
Level of static pain during second day after the day of discharge
Level of pain at rest referred by the patient using a numeric rating scale from 0 to 10
Time frame: 72 hours after surgery
intraoperative morphine equivalent consumption
total amount of morphine equivalent opioid requirement in milligrams
Time frame: intraoperative period
postoperative morphine equivalent consumption
total amount of morphine equivalent opioid requirement in milligrams
Time frame: 24 hours after surgery
sensory block in PACU
loss of sensation to cold in lateral deltoid area
Time frame: 30 minutes after arrival to PACU
Motor block in PACU
paresia or paralysis in operated side, shoulder, arm, forearm or hand
Time frame: 30 minutes after arrival to PACU
sensory block previous to discharge
loss of sensation to cold in lateral deltoid area
Time frame: 24 hours after surgery
motor block previous to discharge
paresia or paralysis in operated side shoulder, arm, forearm or hand
Time frame: 24 hours after surgery
Incidence of side effects before discharge
presence of side effects (vascular puncture, Horner syndrome, hoarseness, LA systemic toxicity, catheter dislodgement, catheter insertion site leak), related with the block.
Time frame: 24 hours after surgery
incidence of side effects after discharge with ambulatory continuous ISB.
presence of side effects (vascular puncture, Horner syndrome, hoarseness, LA systemic toxicity, catheter dislodgement, catheter insertion site leak), related with the block.
Time frame: 24 to 72 hours after surgery
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