Key result
Beta-blockers are linked to a complete absence of vasovagal events during sitting shoulder arthroscopy.
Why the study?
Does beta-adrenergic blocker administration prevent vasovagal events in patients undergoing shoulder arthroscopy in the sitting position with interscalene block?
Observational (n=116)
Does beta-adrenergic blocker administration prevent vasovagal events in patients undergoing shoulder arthroscopy in the sitting position with interscalene block?
Absolute Event Rate: 0% vs 18.75%
p-value: p=< 0.05
Vasovagal events during shoulder arthroscopy in the sitting position with interscalene block may be mediated by the Bezold-Jarisch reflex, triggered by epinephrine and potentially mitigated by beta-blockers.
A retrospective analysis of 116 patients who underwent shoulder arthroscopy in the sitting position with interscalene block (ISB) revealed 20 patients who experienced potentially dangerous vasovagal events characterized by sudden severe hypotension and bradycardia (Group 1).The event occurred 61 +/- 18 min after the block placement. Ninety-six patients (Group 2) did not experience a vasovagal event. Of the patients in Group 2, 18 received beta-adrenergic blockers for increasing heart rate and/or arterial blood pressure (Group 2B) while 78 did not (Group 2A). The number receiving beta-adrenergic blockers was significantly greater than in Group 1 (18/96 vs 0/20, P < 0.05). There were no significant demographic or baseline hemodynamic differences between groups, but the beta-adrenergic blocker and vagal groups showed significantly greater intraoperative peak heart rates (P < 0.05). All patients received epinephrine in their local anesthetic for ISB, incision sites, and articular irrigating solution. Total and weight-corrected epinephrine doses differed significantly between groups (lowest in Group 2A, P < 0.01). Activation of the Bezold-Jarisch reflex, induced by increased circulating epinephrine levels and the sitting position, is the postulated mechanism. (Anesth Analg 1995;80:1158-62)
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D’Alessio et al. (1995) conducted an observational in Shoulder arthroscopy in the sitting position with interscalene block (n=116). Vasovagal event vs. No vasovagal event was evaluated on receipt of beta-adrenergic blockers (p=< 0.05). Patients experiencing vasovagal events during shoulder arthroscopy in the sitting position were significantly less likely to have received beta-adrenergic blockers compared to those without events (0% vs 18.8%, P<0.05).
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