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Jo Yumin,Oh Chahyun,Lee Woo-Yong,Chung Hyung-Jin,Park Hanmi,Park Juyeon,Lee Jieun,김윤희,고영권,Chung Woosuk,Hong Boohwi 대한마취통증의학회 2024 Korean Journal of Anesthesiology Vol.77 No.1
Background: Among the various diaphragm-sparing alternatives to interscalene block, costoclavicular block (CCB) demonstrated a low hemidiaphragmatic paresis (HDP) occurrence but an inconsistent analgesic effect in arthroscopic shoulder surgery. We hypothesized that a larger volume of local anesthetic for CCB could provide sufficient analgesia by achieving sufficient supraclavicular spreading.Methods: Sixty patients scheduled for arthroscopic rotator cuff repair were randomly assigned to receive CCB using one of two volumes of local anesthetic (CCB20, 0.75% ropivacaine 20 ml; CCB40, 0.375% ropivacaine 40 ml). The primary outcome was the rate of complete analgesia (0 on the numeric rating scale of pain) at 1 h postoperatively. The secondary outcomes included a sonographic assessment of local anesthetic spread, diaphragmatic function, pulmonary function, postoperative opioid use, and other pain-related experiences within 24 h postoperatively. Results: The rates of complete analgesia were not significantly different (23.3% [7/30] and 33.3% [10/30] in the CCB20 and CCB40 groups, respectively; risk difference 10%, 95% CI [–13, 32], P = 0.567). There were no significant differences in other pain-related outcomes. Among the clinical factors considered, the only factor significantly associated with postoperative pain was the sonographic observation of supraclavicular spreading. There were no significant differences in the incidence of HDP and the change in pulmonary function between the two groups.Conclusions: Using 40 ml of local anesthetic does not guarantee supraclavicular spread during CCB. Moreover, it does not result in a higher rate of complete analgesia compared to using 20 ml of local anesthetic in arthroscopic shoulder surgery.
Pak Yujin,Baek Sujin,Bang Minhae,Kim Hoseop,Jo Yumin,Oh Chahyun,Hong Boohwi 조선대학교 의학연구원 2023 Medical Bilogical Science and Engineering Vol.6 No.1
Regional anesthesia has become an alternative to general anesthesia in patients with risk factors that may cause perioperative complications. The transversalis fascial plane block (TFPB) is a useful regional technique for blocking the ilioinguinal and iliohypogastric nerves. An 87-yearold female patient with symptomatic severe aortic stenosis was scheduled to undergo open reduction and fixation with an autogenous iliac crest bone graft (ICBG) for the nonunion of the proximal shaft of an ulnar fracture. General anesthesia was avoided due to cardiac comorbidities; therefore, regional anesthesia was considered. ICBG can be performed under spinal anesthesia. However, we performed TFPB since severe aortic stenosis is a contraindication for spinal anesthesia. A brachial plexus block was performed for the primary forearm surgical site. The surgery proceeded safely without any hemodynamic compromise or special events. TFPB for ICBG can be a useful alternative in patients with severe cardiac comorbidities to avoid perioperative risks.