American Society of Regional Anesthesia and Pain Medicine May 2018 - 6

Regional Anesthesia Articles of the Year, 2017

T

he field of regional anesthesia expands and improves thanks to
the work of countless investigators who pour tremendous effort
into crafting well-designed studies. Knowledge creation races
ahead; every year, we have more and more to know. To support the
increased pace of regional anesthesia research, in 2018, Regional
Anesthesia and Pain Medicine is expanding from six to now eight
issues per year. Staying up to date can be a challenge, requiring
delving into multiple journals and selecting studies to read based on
titles, abstracts, or peer recommendations. To assist your reading,
we have conducted an informal survey of all United States and
Canadian regional anesthesiology fellowship directors, asking them
to identify the most important articles of 2017, excluding editorials.
None of the four top articles selected describes a novel technique.
Rather, they use various methods to help guide care and block
selection in common clinical conditions. This theme highlights the
lack of agreement in the regional anesthesia literature around what
constitutes optimal care or if one therapy can be shown to be superior
to others. The methods employed in these articles also vary, including
a randomized controlled trial (RCT), a large retrospective database
analysis, a scoping review, and a network meta-analysis. Interestingly,
the study design choices can result in different conclusions, as
illustrated by the two total knee arthroplasty (TKA) studies selected.

Christopher Lam, MD
Resident Physician
Geisinger Medical Center
Danville, Pennsylvania

Priyanka Ghosh, MD
Resident
Beth Israel Deaconess Medical Center
Boston, Massachusetts

Following are brief synopses of the selected top articles of 2017, in
no particular order.
Auyong DB, Yuan SC, Choi DS, Pahang JA, Slee AE,
Hanson NA. A double-blind randomized comparison of
continuous interscalene, supraclavicular, and suprascapular
blocks for total shoulder arthroplasty. Reg Anesth
Pain Med 2017;42(3):302-309. https://doi.org/10.1097/
AAP.0000000000000578
Auyong et al investigated the respiratory and analgesic effects of
three different brachial plexus blocks for shoulder arthroplasty.
They conducted a 75-patient RCT of continuous interscalene,
supraclavicular, or suprascapular blocks, randomizing in a 1:1:1
ratio with 25 patients per group. The primary outcome was the
assessment of vital capacity by spirometry after 24 hours of
continuous nerve block infusion at 6 mL/h of 0.2% ropivacaine
without an initial bolus. The continuous interscalene and
supraclavicular groups had large decreases in vital capacity, with
mean decreases of 991 mL and 803 mL, respectively. Differences
between the interscalene and supraclavicular groups were not
statistically significant. The continuous suprascapular group
fared better, with a mean vital capacity reduction of only 464 mL,
which was significantly better than either of the other groups.
Secondary outcomes studied included diaphragm excursion by
ultrasound, pain scores, opioid consumption, and adverse effects.
Significantly decreased diaphragmatic excursion was identified
in the interscalene group compared with the supraclavicular

6

Thomas Cochran, MD
Brian F. S. Allen, MD
Resident
Assistant Professor
Vanderbilt University Medical Center
Nashville, Tennessee

group (p = .012) and the suprascapular group (p < .001). Pain
scores by numeric rating scale (2.2, 1.6, and 2.6) and 24-hour
opioid consumption (13.8 mg, 9.9 mg, and 21.8 mg intravenous
morphine equivalents) for groups interscalene, supraclavicular,
and suprascapular, respectively, were not significantly different.
Fewer adverse effects (ie, Horner syndrome, dyspnea, and
hoarseness) were noted in the suprascapular group compared
with the interscalene group (p = .002). The findings suggested
that continuous suprascapular blockade can preserve pulmonary
function for shoulder arthroscopy patients better than interscalene
or supraclavicular approaches, without increasing pain or opioid use.
Malekpour M, Hashmi A, Dove J, Torres D, Wild J.
Analgesic choice in management of rib fractures. Anesth
Analg 2017;124(6):1906-1911. https://doi.org/10.1213/
ANE.0000000000002113
Malekpour et al explored the role of epidural analgesia (EA)
compared to paravertebral block (PVB) in treating rib fractures via

American Society of Regional Anesthesia and Pain Medicine
2018
https://doi.org/10.1097/AAP.0000000000000578 https://doi.org/10.1097/AAP.0000000000000578 https://doi.org/10.1213/ANE.0000000000002113 https://doi.org/10.1213/ANE.0000000000002113
Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine May 2018
