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Anesth Analg 1999;88:378
© 1999 International Anesthesia Research Society

REGIONAL ANESTHESIA AND PAIN MANAGEMENT

ß-Adrenergic Blockers and Vasovagal Episodes During Shoulder Surgery in the Sitting Position Under Interscalene Block

Richard L. Kahn, MD, and Mary J. Hargett, BS

Department of Anesthesiology, Hospital for Special Surgery, New York, New York

Address correspondence and reprint requests to Richard L. Kahn, MD, Department of Anesthesiology, Hospital for Special Surgery, 535 East 70 St., New York, NY 10021.

Shoulder surgery is often performed with patients in the sitting position under interscalene block anesthesia. Vasovagal episodes, characterized by a sudden decrease in heart rate and/or blood pressure, have a reported incidence of 17%–24% in this setting. We performed a retrospective study to determine whether there was an association between the use of ß-adrenergic blockers and the incidence of these episodes. Of the 150 patients identified, 20 (13.3%) had a vasovagal event. Similar proportions of patients had received a ß-adrenergic blocker in the group who had a vasovagal event compared with those who did not (20% vs 18%; P = 0.95). No other differences could be identified. We conclude that vasovagal episodes occur frequently in this setting with no identifiable risk factors. ß-adrenergic blockers were not associated retrospectively with either an increased or decreased incidence of these episodes. The most likely mechanism involves the Bezold-Jarisch reflex.

Implications: In this retrospective study of 150 patients who underwent shoulder surgery in the sitting position under interscalene block, we found a 13% incidence of vasovagal episodes. Unlike a previous study, this was not affected by the use of ß-blockers. A randomized, prospective study is necessary to clarify this issue.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1999 by the International Anesthesia Research Society.