Perioperative hemodynamics in hypertensive patients undergoing shoulder surgery with interscalene block in the sitting position: An observational study

Objective: To investigate the effects of the interscalene block technique on blood pressure changes in medically controlled hypertensive patients undergoing shoulder arthroscopy in the sitting position. Design: A prospective and observational study Setting: Operating room and postoperative recovery area Subjects: Sixty-four American Society of Anesthesiologists I-II adult (medically controlled hypertensive (n=32) and normotensive (n=32)) patients scheduled to have elective arthroscopic shoulder surgery with the interscalene block technique. Intervention(s): Ultrasound-guided interscalene block administered using 15/cc 0.5% bupivacaine and 5/cc 2% lidocaine. Blood pressures and heart rate were recorded at five-minute intervals for 60 minutes. Main outcome measures: The relationship between the interscalene block and 20% or more increase in the systolic blood pressure at any time interval compared to the baseline Results: None of the normotensive patients had 20% or more increase in the systolic blood pressure. However, 62.5% of the hypertensive patients had 20% or higher systolic blood pressure values after the interscalene block during the follow-up (P<0.0001). Four hypertensive patients developed a hypertensive crisis after interscalene block. Conclusions: Consequently, interscalene block caused an increase in the blood pressures of medically controlled hypertensive patients. In daily practice, caution is warranted when selecting the anesthesia type, especially in patients with uncontrolled hypertension and with comorbidities, who cannot tolerate acute upsurges in blood pressure.