The effects of shoulder arthroscopy on ultrasound image quality of the interscalene brachial plexus: a pre-procedure vs post-procedure comparative study

• Published in: BMC anesthesiology Vol. 21; no. 1; p. 187
• Main Authors: Panchamia, Jason K, Jagannathan, Ram, Pulos, Bridget P, Amundson, Adam W, Sanchez-Sotelo, Joaquin, Martin, David P, Smith, Hugh M
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 09.07.2021; BioMed Central; BMC
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia; Apnea; Arthroscopy; Arthroscopy - methods; Body Mass Index; Brachial plexus; Brachial Plexus - diagnostic imaging; Brachial plexus block; Brachial Plexus Block - methods; Comparative analysis; Endoscopic surgery; Extravasation; Extravasation of diagnostic and therapeutic materials; Female; Health aspects; Humans; Informed consent; Joints; Male; Medical personnel; Middle Aged; Neck; Patients; Prospective Studies; Risk groups; Shoulder; Shoulder - surgery; Sleep; Sleep apnea syndromes; Sleep disorders; Surgery; Ultrasonic imaging; Ultrasonography; Ultrasonography, Interventional - methods; Ultrasound; Ultrasound imaging; Young Adult; United States > US; Extravasation of diagnostic and therapeutic materials; Arthroscopy; Brachial plexus block; Ultrasonography
• ISSN: 1471-2253; 1471-2253
• DOI: 10.1186/s12871-021-01409-3

Fluid extravasation from the shoulder compartment and subsequent absorption into adjacent soft tissue is a well-documented phenomenon in arthroscopic shoulder surgery. We aimed to determine if a qualitative difference in ultrasound imaging of the interscalene brachial plexus exists in relation to the timing of performing an interscalene nerve block (preoperative or postoperative). This single-center, prospective observational study compared pre- and postoperative interscalene brachial plexus ultrasound images of 29 patients undergoing shoulder arthroscopy using a pretest-posttest methodology where individual patients served as their own controls. Three fellowship-trained regional anesthesiologists evaluated image quality and confidence in performing a block for each ultrasound scan using a five-point Likert scale. The association of image quality with age, gender, BMI, duration of surgery, obstructive sleep apnea, and volume of arthroscopic irrigation fluid were analyzed as secondary outcomes. Aggregate preoperative mean scores in quality of ultrasound visualization were higher than postoperative scores (preoperative 4.5 vs postoperative 3.8; p < .001), as was confidence in performing blockade based upon the imaging (preoperative 4.8 vs postoperative 4.2; p < .001). Larger BMI negatively affected visualization of the brachial plexus in the preoperative period (p < 0.05 for both weight categories). Patients with intermediate-high risk or confirmed obstructive sleep apnea had lower aggregate postoperative mean scores compared to the low-risk group for both ultrasound visualization (3.4 vs 4.0; p < .05) and confidence in block performance (3.8 vs 4.4; p < .05). Due to the potential reduction of ultrasound visualization of the interscalene brachial plexus after shoulder arthroscopy, we advocate for a preoperative interscalene nerve block when feasible. ClinicalTrials.gov ( NCT03657173 ; September 4, 2018).