Regionalanästhesie der Nervi supraclaviculares und der C5 Nervenwurzel bei operativer Therapie von Verletzungen der Clavicula. Einfluss auf postoperative Analgesie und Lungenparameter.
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Philipps-Universität Marburg
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Abstract
Clavicle fractures and AC-joint dislocations are common among athletic adults and represent a major part of the injuries involving the shoulder girdle. Although peripheral nerve blocks are widely used in upper extremity surgery, there is no common use in clavicle surgery. Due to the complex innervation of the clavicle from both the plexus brachialis and the plexus cervicalis, the choice of the most suitable technique still remains controversial.
The aim of this randomized controlled study was to determine an adequate regional anaesthesia technique and to contribute towards an establishment of a new standard for postoperative pain management in clavicle surgery. Besides the postoperative analgesic quality, the incidence of phrenic nerve palsy and the oxygen saturation were investigated.
After obtaining ethics committee approval, 60 patients planned for elective clavicle or AC-joint surgery have been recruited between April 01, 2019 and November 30, 2020. After exclusion of 4 patients, 56 patients were randomized into 3 different study groups. In the first group surgery was performed under general anaesthesia with combined nerve block of the supraclavicular nerves and the C5 root with 10 ml of local anaesthetic (NSCL+C5-group; n= 19). In the second group surgery was performed under general anaesthesia with single C5 root block with 5 ml of local anaesthetic (C5-group; n= 18). The third group underwent surgery only in general anaesthesia with systemic analgesia (control group; n= 19). Peripheral nerve block was performed using the ultrasound guided in-plane technique with a single-shot injection of Ropivacaine (7,5 mg/ml) and Prilocaine (1 mg/ml) before general anaesthesia was induced. Primary endpoints of this study were postoperative levels of pain (NRS) and piritramide consumption. Secondary endpoints were the movement of the ipsilateral diaphragm as a sign of phrenic nerve palsy detected by ultrasound and oxygen saturation using pulse oximetry. Measurements were evaluated preoperative (baseline) and postoperative at specific points t0 (Patient arrives in postanaesthesia care unit), t0,5 (after 30 minutes.), t1 (after 60 min), and t24 (after 24 h).
Patients in the NSCL+C5-group had no postoperative pain during the first hour (NRS= 0), which was significantly less compared to the C5-group (NRS t0= 1,9; NRS t0,5= 2,9; NRS t1= 2,2) and the control group (NRS t0= 4,5; NRS t0,5= 4,4; NRS t1= 3,2). Furthermore, there was no additional piritramide needed in the NSCL+C5-group, which was also significantly less than in the C5-group (4,4 mg) as well as in the control group (12,6 mg). The incidence of phrenic nerve palsy was higher in the NSCL+C5-group (t0= 32%) with an obvious decline in ipsilateral diaphragm movement. Oxygen saturation was slightly reduced in all groups, whereas the NSCL+C5-group still showed the highest values. In the first postoperative hour oxygen saturation in the NSCL+C5-group was significantly higher than in the control group. At t24 there were no differences between the groups concerning primary and secondary endpoints any more.
Based on these results the conclusion can be drawn, that supplemental regional anaesthesia of the supraclavicular nerves and the C5 root combined is an appropriate method to avoid postoperative pain and significantly reduce piritramide consumption in clavicle surgery. Despite an increased incidence of phrenic nerve palsy with subsequent decline in diaphragm movement in the NSCL+C5-group, there was no negative impact on oxygen saturation or relevant clinical sign of desaturation. Studies investigating the efficacy of this this regional anaesthesia technique as an exclusive method without general anaesthesia would be of great interest, too. Therefore, further randomized controlled trials are needed.
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Created: 2021Issued: 2022-02-03Updated: 2022-02-03
Faculty
Medizin
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Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
clavicle fractureregional anaesthesiaAC-Gelenksluxationphrenic nerve palsyPhrenikuspareseperiphere RegionalanästhesieClaviculafrakturAC-joint dislocationanalgesic qualitypostoperative Analgesie
DFG-subjects
RegionalanästhesieSchmerztherapie
DDC-Numbers
610
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Schaefer, Martin Julian: Regionalanästhesie der Nervi supraclaviculares und der C5 Nervenwurzel bei operativer Therapie von Verletzungen der Clavicula. Einfluss auf postoperative Analgesie und Lungenparameter.. : Philipps-Universität Marburg 2022-02-03. DOI: https://doi.org/10.17192/z2022.0035.
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This item has been published with the following license: In Copyright