Risk factors for insufficient ultrasound‐guided supraclavicular brachial plexus block
Abstract Purpose Ultrasound‐guided supraclavicular brachial plexus block (SCBPB) is performed by surgeons for upper limb anesthesia; however, certain patients need additional local anesthesia. This study aimed to identify risk factors for additional local anesthetic injection requirements. Methods I...
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| Format: | Article |
| Language: | English |
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Wiley
2023-01-01
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| Series: | Journal of Experimental Orthopaedics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40634-023-00611-1 |
| _version_ | 1797270796558663680 |
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| author | Shingo Abe Hiroki Kondo Yohei Tomiyama Toshiki Shimada Masayuki Bun Kohji Kuriyama |
| author_facet | Shingo Abe Hiroki Kondo Yohei Tomiyama Toshiki Shimada Masayuki Bun Kohji Kuriyama |
| author_sort | Shingo Abe |
| collection | DOAJ |
| description | Abstract Purpose Ultrasound‐guided supraclavicular brachial plexus block (SCBPB) is performed by surgeons for upper limb anesthesia; however, certain patients need additional local anesthesia. This study aimed to identify risk factors for additional local anesthetic injection requirements. Methods In total, 269 patients receiving ultrasound‐guided SCBPB were enrolled. Patient age, sex, body mass index, anesthetic drug dose, surgeon expertise (hand surgeon or resident), tourniquet time, comorbidities (diabetes mellitus and mental disorders), and preoperative blood pressure representing anxiety were compared between the additional local anesthesia and no additional local anesthesia groups matched for background using propensity scores. Receiver operating characteristic analysis was performed to determine risk factor cut‐off values with the highest predictive potential. Results Of 269 patients, 41 (15.2%) required additional intraoperative local anesthesia. Among surgical sites, elbow surgery showed the highest prevalence of the need for additional local anesthesia (17/41, 41%). A high body mass index and high systolic blood pressure before surgery were identified as risk factors for additional intraoperative local anesthesia requirement. Furthermore, systolic blood pressure > 170 mmHg (area under the curve, 0.66) predicted the need for intraoperative local anesthesia with 36% sensitivity, 89% specificity, 37.5% positive predictive value, and 88.6% negative predictive value. The median systolic blood pressure was significantly greater in patients requiring additional local anesthesia than in those not requiring it [151 (139–171) mmHg vs. 145 (127–155) mmHg; P = 0.026]. Conclusion Elbow surgery, obesity, and high systolic blood pressure (> 170 mmHg) before surgery are predictive of additional intraoperative local anesthesia requirement. Level of Evidence Prognostic Level III |
| first_indexed | 2024-03-08T04:57:47Z |
| format | Article |
| id | doaj.art-c050a0f1ea8e4ed6a2218d88305b93cb |
| institution | Directory Open Access Journal |
| issn | 2197-1153 |
| language | English |
| last_indexed | 2024-04-25T02:09:58Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Experimental Orthopaedics |
| spelling | doaj.art-c050a0f1ea8e4ed6a2218d88305b93cb2024-03-07T12:46:41ZengWileyJournal of Experimental Orthopaedics2197-11532023-01-01101n/an/a10.1186/s40634-023-00611-1Risk factors for insufficient ultrasound‐guided supraclavicular brachial plexus blockShingo Abe0Hiroki Kondo1Yohei Tomiyama2Toshiki Shimada3Masayuki Bun4Kohji Kuriyama5Toyonaka Municipal Hospital4‐14‐1 Shibahara560‐8565ToyonakaOsakaJapanToyonaka Municipal Hospital4‐14‐1 Shibahara560‐8565ToyonakaOsakaJapanToyonaka Municipal Hospital4‐14‐1 Shibahara560‐8565ToyonakaOsakaJapanDepartment of Orthopaedic SurgeryOsaka University Graduate School of Medicine2‐2 Yamadaoka565‐0871SuitaOsakaJapanDepartment of Orthopaedic SurgeryOsaka University Graduate School of Medicine2‐2 Yamadaoka565‐0871SuitaOsakaJapanToyonaka Municipal Hospital4‐14‐1 Shibahara560‐8565ToyonakaOsakaJapanAbstract Purpose Ultrasound‐guided supraclavicular brachial plexus block (SCBPB) is performed by surgeons for upper limb anesthesia; however, certain patients need additional local anesthesia. This study aimed to identify risk factors for additional local anesthetic injection requirements. Methods In total, 269 patients receiving ultrasound‐guided SCBPB were enrolled. Patient age, sex, body mass index, anesthetic drug dose, surgeon expertise (hand surgeon or resident), tourniquet time, comorbidities (diabetes mellitus and mental disorders), and preoperative blood pressure representing anxiety were compared between the additional local anesthesia and no additional local anesthesia groups matched for background using propensity scores. Receiver operating characteristic analysis was performed to determine risk factor cut‐off values with the highest predictive potential. Results Of 269 patients, 41 (15.2%) required additional intraoperative local anesthesia. Among surgical sites, elbow surgery showed the highest prevalence of the need for additional local anesthesia (17/41, 41%). A high body mass index and high systolic blood pressure before surgery were identified as risk factors for additional intraoperative local anesthesia requirement. Furthermore, systolic blood pressure > 170 mmHg (area under the curve, 0.66) predicted the need for intraoperative local anesthesia with 36% sensitivity, 89% specificity, 37.5% positive predictive value, and 88.6% negative predictive value. The median systolic blood pressure was significantly greater in patients requiring additional local anesthesia than in those not requiring it [151 (139–171) mmHg vs. 145 (127–155) mmHg; P = 0.026]. Conclusion Elbow surgery, obesity, and high systolic blood pressure (> 170 mmHg) before surgery are predictive of additional intraoperative local anesthesia requirement. Level of Evidence Prognostic Level IIIhttps://doi.org/10.1186/s40634-023-00611-1Brachial plexus blockUltrasound‐guided supraclavicular approachInsufficient blockRisk factorsAdditional local anesthesia |
| spellingShingle | Shingo Abe Hiroki Kondo Yohei Tomiyama Toshiki Shimada Masayuki Bun Kohji Kuriyama Risk factors for insufficient ultrasound‐guided supraclavicular brachial plexus block Journal of Experimental Orthopaedics Brachial plexus block Ultrasound‐guided supraclavicular approach Insufficient block Risk factors Additional local anesthesia |
| title | Risk factors for insufficient ultrasound‐guided supraclavicular brachial plexus block |
| title_full | Risk factors for insufficient ultrasound‐guided supraclavicular brachial plexus block |
| title_fullStr | Risk factors for insufficient ultrasound‐guided supraclavicular brachial plexus block |
| title_full_unstemmed | Risk factors for insufficient ultrasound‐guided supraclavicular brachial plexus block |
| title_short | Risk factors for insufficient ultrasound‐guided supraclavicular brachial plexus block |
| title_sort | risk factors for insufficient ultrasound guided supraclavicular brachial plexus block |
| topic | Brachial plexus block Ultrasound‐guided supraclavicular approach Insufficient block Risk factors Additional local anesthesia |
| url | https://doi.org/10.1186/s40634-023-00611-1 |
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