A prospective clinical registry of ultrasound-guided regional anesthesia for ambulatory shoulder surgery.
BACKGROUND
There is a lack of clinical registries to document efficacy and safety of ultrasound-guided regional anesthesia. Interscalene blocks are effective for shoulder arthroscopy, and ultrasound guidance may reduce risk. Furthermore, ultrasound-guided supraclavicular block is a novel approach for shoulder anesthesia that may have less risk for neurological symptoms than interscalene block.


METHODS
One thousand one hundred sixty-nine patients undergoing ultrasound-guided regional anesthesia for ambulatory shoulder arthroscopy were enrolled in our prospective registry. Standardized perioperative data were collected including a preoperative neurological screening tool. Either interscalene or supraclavicular block was performed at the discretion of the clinical team. Standardized follow-up was performed in the postanesthesia care unit and at 1 week. Postoperative neurological symptoms (PONS) were assessed at the 1-week follow-up with the same screening tool by a blinded neurologist.


RESULTS
Ultrasound-guided interscalene (n = 515) and supraclavicular (n = 654) blocks had excellent anesthetic success (99.8%; 95% confidence interval [CI], 99.4%-99.9%) with 0% (95% CI, 0%-0.3%) incidence of vascular puncture or intravascular injection. The incidence of hoarseness in the postanesthesia care unit was significantly less with supraclavicular (22% with 95% CI, 19%-26%) than interscalene block (31% with 95% CI, 27%-35%). The incidence of dyspnea was similar (7% for supraclavicular vs 10% with interscalene). No patient had a clinically apparent pneumothorax. The incidence of PONS was very low (0.4% with 95% CI, 0.1%-1%), and there was a 0% (95% CI, 0%-0.3%) incidence of permanent nerve injury.


CONCLUSIONS
Ultrasound-guided interscalene and supraclavicular blocks are effective and safe for shoulder arthroscopy. Temporary and permanent PONS is uncommon.
Liu
Spencer S
SS
Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021, USA. liusp@hss.ed
Gordon
Michael A
MA
Shaw
Pamela M
PM
Wilfred
Sarah
S
Shetty
Teena
T
Yadeau
Jacques T
JT
D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D001182:Arthroscopy; D001808:Blood Vessels / Q000293:injuries; D016292:Procedural Sedation; D004558:Electric Stimulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D011183:Postoperative Complications / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011446:Prospective Studies; D012042:Registries; D018401:Sample Size; D012782:Shoulder / Q000000981:diagnostic imaging* / Q000601:surgery*; D014463:Ultrasonography