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Background. The role and significance of the technical aspects of interscalene brachial plexus block in the occurrence of sudden arterial hypotension and bradycardia events during shoulder arthroscopy in a semi-sitting position are ambiguous. Aim. The study aimed to assess the effect of interscalene brachial plexus block on the incidence of hypotension-bradycardia events during shoulder arthroscopic surgery in adolescents in a semi-sitting position. Materials and methods. This retrospective analysis of anesthesia protocols included 288 patients who underwent arthroscopic shoulder surgery in a semi-sitting position under the interscalene brachial plexus block. Regional blockades were performed with neurostimulation in Group 1 ( n = 23), neurostimulation and ultrasound navigation without repositioning the needle in Group 2 ( n = 70), and neurostimulation and ultrasound navigation with multiple precision repositioning the needle in Group 3 ( n = 195). Results. Hypotension-bradycardia events were detected in 26 patients out of 288 (9%). There was a statistically significant difference in the frequency of hypotension-bradycardia in all groups: 10 (43.48%) in Group 1, 15 (21.43%) in Group 2, and 1 (0.51%) in Group 3 ( p = 0.000). A direct correlation between hypotension-bradycardia episodes and local anesthetic volume ( r = 0.405; p < 0.05), and Horner’s syndrome ( r = 0.684, p < 0.05) was found. Conclusions. Interscalene brachial plexus block with a target delivery of low volume of local anesthetic and dual navigation reduces the risk of hypotension-bradycardia. Horner’s syndrome can be considered an early predictor of hypotension-bradycardia events.

Effect of brachial plexus block on the incidence of arterial hypotension and bradycardia events during shoulder arthroscopy in adolescents