Costoclavicular block as a diaphragm-sparing nerve block for shoulder surgery: a randomized controlled trial
Background Distal nerve block approaches have been explored to reduce hemidiaphragmatic paresis (HDP) more effectively than interscalene block (ISB). However, these approaches are associated with a high incidence of HDP. The costoclavicular block (CCB) provides effective analgesia while reducing HDP...
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Korean Society of Anesthesiologists
2025-02-01
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| Series: | Korean Journal of Anesthesiology |
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| Online Access: | http://ekja.org/upload/pdf/kja-24595.pdf |
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| author | Youngin Lee Seunguk Bang Jihyun Chung Min Suk Chae Jungwon Shin |
| author_facet | Youngin Lee Seunguk Bang Jihyun Chung Min Suk Chae Jungwon Shin |
| author_sort | Youngin Lee |
| collection | DOAJ |
| description | Background Distal nerve block approaches have been explored to reduce hemidiaphragmatic paresis (HDP) more effectively than interscalene block (ISB). However, these approaches are associated with a high incidence of HDP. The costoclavicular block (CCB) provides effective analgesia while reducing HDP. Here, we hypothesized that CCB would decrease the incidence of HDP compared to ISB while still providing effective pain relief after surgery. Methods Seventy patients who underwent arthroscopic rotator cuff repair were randomly allocated to receive either ultrasound-guided CCB (n = 35) or ISB (n = 35). Each group received 0.2% ropivacaine (20 ml CCB, 10 ml ISB). The primary outcome was the incidence of HDP, as measured using M-mode ultrasound. Diaphragmatic excursion, pulmonary function test results, opioid consumption, and pain scores were evaluated. Results Sixty-six patients were included. CCB group had a significantly lower incidence of HDP than those in the ISB group (5.9% vs. 84.4%, P < 0.001). The diaphragmatic excursion reduction was significantly more in the ISB (3.87 cm) group than in the CCB (0.25 cm) group (P < 0.001). The decrease in forced vital capacity and forced expiratory volume in 1 s from baseline was significantly greater in the ISB. There was no significant difference in opioid consumption between the two groups during the entire postoperative period. Conclusions Compared with ISB, CCB significantly reduced the incidence of HDP while maintaining effective analgesia and causing less pulmonary function impairment. CCB may be a viable option for diaphragmatic-sparing analgesia after shoulder surgery. |
| format | Article |
| id | doaj-art-4daf3888d6194c7c8cc0016e21cd8cd0 |
| institution | Kabale University |
| issn | 2005-6419 2005-7563 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Korean Society of Anesthesiologists |
| record_format | Article |
| series | Korean Journal of Anesthesiology |
| spelling | doaj-art-4daf3888d6194c7c8cc0016e21cd8cd02025-02-03T08:32:46ZengKorean Society of AnesthesiologistsKorean Journal of Anesthesiology2005-64192005-75632025-02-01781303810.4097/kja.245959022Costoclavicular block as a diaphragm-sparing nerve block for shoulder surgery: a randomized controlled trialYoungin Lee0Seunguk Bang1Jihyun Chung2Min Suk Chae3Jungwon Shin4 Department of Anesthesiology and Pain Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea Department of Anesthesiology and Pain Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea Department of Anesthesiology and Pain Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea Department of Anesthesiology and Pain Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, KoreaBackground Distal nerve block approaches have been explored to reduce hemidiaphragmatic paresis (HDP) more effectively than interscalene block (ISB). However, these approaches are associated with a high incidence of HDP. The costoclavicular block (CCB) provides effective analgesia while reducing HDP. Here, we hypothesized that CCB would decrease the incidence of HDP compared to ISB while still providing effective pain relief after surgery. Methods Seventy patients who underwent arthroscopic rotator cuff repair were randomly allocated to receive either ultrasound-guided CCB (n = 35) or ISB (n = 35). Each group received 0.2% ropivacaine (20 ml CCB, 10 ml ISB). The primary outcome was the incidence of HDP, as measured using M-mode ultrasound. Diaphragmatic excursion, pulmonary function test results, opioid consumption, and pain scores were evaluated. Results Sixty-six patients were included. CCB group had a significantly lower incidence of HDP than those in the ISB group (5.9% vs. 84.4%, P < 0.001). The diaphragmatic excursion reduction was significantly more in the ISB (3.87 cm) group than in the CCB (0.25 cm) group (P < 0.001). The decrease in forced vital capacity and forced expiratory volume in 1 s from baseline was significantly greater in the ISB. There was no significant difference in opioid consumption between the two groups during the entire postoperative period. Conclusions Compared with ISB, CCB significantly reduced the incidence of HDP while maintaining effective analgesia and causing less pulmonary function impairment. CCB may be a viable option for diaphragmatic-sparing analgesia after shoulder surgery.http://ekja.org/upload/pdf/kja-24595.pdfanalgesiaarthroscopybrachial plexus blockcostoclavicularnerve blockpain, postoperativephrenic nerveshoulderthoracic outlet syndrome |
| spellingShingle | Youngin Lee Seunguk Bang Jihyun Chung Min Suk Chae Jungwon Shin Costoclavicular block as a diaphragm-sparing nerve block for shoulder surgery: a randomized controlled trial Korean Journal of Anesthesiology analgesia arthroscopy brachial plexus block costoclavicular nerve block pain, postoperative phrenic nerve shoulder thoracic outlet syndrome |
| title | Costoclavicular block as a diaphragm-sparing nerve block for shoulder surgery: a randomized controlled trial |
| title_full | Costoclavicular block as a diaphragm-sparing nerve block for shoulder surgery: a randomized controlled trial |
| title_fullStr | Costoclavicular block as a diaphragm-sparing nerve block for shoulder surgery: a randomized controlled trial |
| title_full_unstemmed | Costoclavicular block as a diaphragm-sparing nerve block for shoulder surgery: a randomized controlled trial |
| title_short | Costoclavicular block as a diaphragm-sparing nerve block for shoulder surgery: a randomized controlled trial |
| title_sort | costoclavicular block as a diaphragm sparing nerve block for shoulder surgery a randomized controlled trial |
| topic | analgesia arthroscopy brachial plexus block costoclavicular nerve block pain, postoperative phrenic nerve shoulder thoracic outlet syndrome |
| url | http://ekja.org/upload/pdf/kja-24595.pdf |
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