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Ali MI, Tang Y, Hou J, Long Y, Zhou C, Wang Z, Yang R. Modified Continuous Arthroscopy-Guided Suprascapular Nerve Block for Postoperative Pain Control Following Rotator Cuff Repair: Surgical Technique. Arthrosc Tech 2023; 12:e1701-e1706. [PMID: 37942096 PMCID: PMC10627854 DOI: 10.1016/j.eats.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/28/2023] [Indexed: 11/10/2023] Open
Abstract
Arthroscopic rotator cuff repair is one of the most painful surgical procedures; patients complain of pain especially during the first 48 hours postoperatively. Pain management is an essential goal to reduce the demand for analgesic agents and patient discomfort. Various methods have been introduced for arthroscopic rotator cuff repair, including continuous arthroscopy-guided suprascapular nerve blocks (SSNB) and interscalene nerve blocks. However, the aforementioned procedures have shown disadvantages such as catheter mobilization, which may cause injury to the artery, a weak analgesic effect, and Horner syndrome, as well as phrenic nerve paralysis. A modification of the continuous arthroscopy-guided SSNB has been introduced at our hospital: the modified continuous arthroscopy-guided SSNB technique. The aim of this technique is to immobilize the catheter to reduce the chance of injury and minimize postsurgical analgesic needs and patient discomfort.
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Affiliation(s)
- Maslah Idiris Ali
- Department of Orthopedic Surgery, Sport Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yiyong Tang
- Department of Orthopedic Surgery, Sport Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingyi Hou
- Department of Orthopedic Surgery, Sport Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Long
- Department of Orthopedic Surgery, Sport Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chuanhai Zhou
- Department of Orthopedic Surgery, Sport Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiling Wang
- Department of Orthopedic Surgery, Sport Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Yang
- Department of Orthopedic Surgery, Sport Medicine Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Su P, Liu Y, Zhang L, Bai LB. Comparison of Analgesia Treatment Methods After Arthroscopic Rotator Cuff Repair: A Network Meta-analysis of 42 Randomized Controlled Trials. Orthop J Sports Med 2023; 11:23259671231167128. [PMID: 37346775 PMCID: PMC10280546 DOI: 10.1177/23259671231167128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/09/2022] [Indexed: 06/23/2023] Open
Abstract
Background The optimal method for postoperative analgesia after arthroscopic rotator cuff repair (ARCR) is still unclear. Purpose To compare the efficacy of postoperative analgesic methods after ARCR through network meta-analysis of randomized controlled trials and prospective controlled trials. Study Design Systematic review; Level of evidence, 2. Methods Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched PubMed, Embase, and Web of Science from inception until April 12, 2022, for randomized controlled trials and prospective controlled trials evaluating neuraxial analgesia, peripheral nerve block, periarticular local anesthetic infiltration, intravenous patient-controlled analgesia, oral analgesia, or any combination of these methods for pain management after ARCR. Outcomes included pain scores at rest, morphine consumption, and complications (nausea and vomiting). Study quality was assessed using the Cochrane risk-of-bias tool. Network meta-analysis was used to assess the relative efficacy of the methods for postoperative analgesia. The best choice for postoperative analgesia was defined as the one with significant differences in pain scores and morphine consumption compared with placebo, with no significant difference in complications, during the initial 48 hours postoperatively. Results Included were 42 studies with 3110 patients. Only suprascapular nerve block (SSNB) was significantly superior to placebo in pain scores (mean difference [MD], -0.93 [95% CI, -1.31 to -0.54] at 6 hours; MD, -2.34 [95% CI, -3.49 to -1.19] at 12 hours) and morphine consumption (MD, -17.70 [95% CI, -32.98 to -2.42] at 24 hours) (P < .05 for all), with no difference in complications (odds ratio, 0.96 [95% CI, 0.21 to 4.32]; P > .05). Pain scores were significantly lower with interscalene nerve block compared with SSNB (MD, -0.69 [95% CI, -1.17 to -0.20] at 6 hours; MD, -1.44 [95% CI, -2.21 to -0.67] at 12 hours) and with SSNB + axillary nerve block compared with SSNB (MD, -3.09 [95% CI, -4.18 to -1.99] at 6 hours; MD, -0.87 [95% CI, -1.71 to -0.03] at 12 hours) (P < .05 for all). Conclusion Based on the current evidence, most analgesic methods lowered pain and morphine consumption compared with placebo. There were significant differences in pain scores between interscalene nerve block and SSNB during the first 12 hours postoperatively, and adding axillary nerve block to SSNB enhanced the analgesic effect.
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Affiliation(s)
- Peng Su
- Department of Hand and Foot Surgery,
Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Yijia Liu
- Department of Orthopedic Surgery, West
China Hospital, Sichuan University, Chengdu, China
| | - Lu Zhang
- School of Finance, Qilu University of
Technology (Shandong Academy of Sciences), Jinan, China
| | - Long-bin Bai
- Department of Hand and Foot Surgery,
Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
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Jiangping W, Xiaolin Q, Han S, Zhou X, Mao N, Zhibo D, Ting G, Shidong H, Xiangwei L, Xin Y, Guoyin S. Network Meta-Analysis of Perioperative Analgesic Effects of Different Interventions on Postoperative Pain After Arthroscopic Shoulder Surgery Based on Randomized Controlled Trials. Front Med (Lausanne) 2022; 9:921016. [PMID: 35872801 PMCID: PMC9304654 DOI: 10.3389/fmed.2022.921016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundShoulder arthroscopic surgery is a common surgical method used in orthopedics. However, severe postoperative pain can significantly limit the early joint movement of patients and adversely affect the impact of the surgery. At present, there is no consistent and effective analgesic scheme for the management of postoperative pain after arthroscopic surgery of the shoulder.PurposeThe aim of this study was to search for the most effective analgesic scheme to control pain in the perioperative period of arthroscopic surgery of the shoulder.Study DesignNetwork meta-analysis.MethodsWe searched 5 different databases (i.e., Medline, PubMed, Embase, Web of Science, and the Cochrane Library) from January 2011 to January 2021 for English literature. Thereafter, we sifted out randomized controlled trials (RCTs), which compared different intervention schemes for pain management after shoulder arthroscopy and selected only 12 h, 24 h, or 48 h after the patient leaves the operating room as an optimal period for administration of analgesic intervention schemes. Only patients with shoulder disease who have undergone arthroscopic shoulder surgery were included in this study. The Cochrane “risk of bias” was used for the quality assessment. Moreover, some additional tests were performed to enhance the credibility of the results.ResultsTwenty-nine RCTs involving 1,885 patients were included in this frequentist network meta-analysis (NMA). These articles mainly were divided into two distinct groups, namely, the nerve block group and the non-nerve block group. Regarding the nerve block group, at postoperative 12 h, the intervention suprascapular nerve block + interscalene nerve block (SSNB + INB) was ranked first, whereas INB + intra-articular injection (INB + IAI) was ranked first at 24 h and 48 h postoperation. In the non-nerve block group, external application (EA) was ranked first at postoperative 12 h, but oral administration (OA) exhibited a better analgesic effect at postoperative 24 h and postoperative 48 h.ConclusionWe conclude that the analgesic effect of SSNB+INB was the best at postoperative 12 h, and INB+IAI was the best at postoperative 24 h and 48 h in the nerve block group. For the non-nerve block group, the effect of EA was the best at postoperative 12 h, and the analgesic effect of OA at postoperative 24 h and 48 h was significantly better than any other interventions.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42021286777.
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Affiliation(s)
- Wu Jiangping
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Quan Xiaolin
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Shu Han
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
- *Correspondence: Shu Han
| | - Xiaolan Zhou
- Medical Record Statistics Section, The Second Hospital of Chongqing Medical University, Chongqing, China
- Xiaolan Zhou
| | - Nie Mao
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Deng Zhibo
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Gong Ting
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Hu Shidong
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Li Xiangwei
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Yuan Xin
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
| | - Shu Guoyin
- Center for Joint Surgery, Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Clinical Research Center for Geriatrics and Gerontology, Chongqing, China
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Kalthoff A, Sanda M, Tate P, Evanson K, Pederson JM, Paranjape GS, Patel PD, Sheffels E, Miller R, Gupta A. Peripheral Nerve Blocks Outperform General Anesthesia for Pain Control in Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis. Arthroscopy 2022; 38:1627-1641. [PMID: 34952185 DOI: 10.1016/j.arthro.2021.11.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this review is to compare the effectiveness of different peripheral nerve blocks and general anesthesia (GA) in controlling postoperative pain after arthroscopic rotator cuff repair (ARCR). METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review was conducted for the period of January 1, 2005, to February 16, 2021, by searching the following databases: PubMed, Cochrane, Embase, and Arthroscopyjournal.org. The primary outcomes of interest included 1-hour, 24-hour, and 48-hour pain scores on a numeric rating scale or visual analog scale (VAS). Inclusion criteria were English language studies reporting on adults (≥18 years) undergoing ARCR with peripheral nerve blockade. To synthesize subjective pain score data at each evaluation time point across studies, we performed random-effects network meta-regression analyses accounting for baseline pain score as a covariate. RESULTS A total of 14 randomized controlled trials with 851 patients were included in the meta-analysis. Data from six different nerve block interventions, single-shot interscalene brachial plexus nerve block (s-ISB; 37.8% [322/851]), single-shot suprascapular nerve block (s-SSNB; 9.9% [84/851]), continuous ISB (c-ISB; 17.5% [149/851]), continuous SSNB (c-SSNB; 6.9% [59/851]), s-ISB combined with SSNB (s-ISB+SSNB; 5.8% [49/851]), s-SSNB combined with axillary nerve block (s-SSNB+ANB; 4.8% [41/851]), as well as GA (17.3% [147/851]) were included. Our meta-analysis demonstrated that c-ISB block had a significant reduction in pain score relative to GA at 1-hour postoperation (mean difference [MD]: -1.8; 95% credible interval [CrI] = -3.4, -.08). There were no significant differences in VAS pain scores relative to GA at 24 and 48 hours postoperatively. However, s-ISB+SSNB had a significant reduction in 48-hour pain score compared to s-ISB (MD = -1.07; 95% CrI = -1.92, -.22). CONCLUSIONS It remains unclear which peripheral nerve block strategy is optimal for ARCR. However, peripheral nerve blocks are highly effective at attenuating postoperative ARCR pain and should be more widely considered as an alternative over general anesthesia alone. LEVEL OF EVIDENCE Level II Systematic review and meta-analysis of Level I and II studies.
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Affiliation(s)
- Andrew Kalthoff
- Department of Orthopedics, Mercy St. Vincent Medical Center, Toledo, Ohio, U.S.A..
| | - Milo Sanda
- Department of Orthopedics, Mercy St. Vincent Medical Center, Toledo, Ohio, U.S.A
| | - Patrick Tate
- Department of Orthopedics, Akron General Medical Center, Akron, Ohio, U.S.A
| | - Kirk Evanson
- Superior Medical Experts, Minneapolis, Minnesota, U.S.A
| | | | | | - Puja D Patel
- Superior Medical Experts, Minneapolis, Minnesota, U.S.A
| | - Erin Sheffels
- Superior Medical Experts, Minneapolis, Minnesota, U.S.A
| | - Richard Miller
- Department of Orthopedics, Mercy St. Vincent Medical Center, Toledo, Ohio, U.S.A
| | - Anil Gupta
- Toledo Orthopedic Surgeons, Toledo, Ohio, U.S.A
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The AAOS 2019 Clinical Practice Guidelines for the Management of Rotator Cuff Injuries Are Unbiased and Incorporate a Diverse Body of Literature. Arthrosc Sports Med Rehabil 2022; 4:e559-e565. [PMID: 35494298 PMCID: PMC9042740 DOI: 10.1016/j.asmr.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyze the scientific research that formed the basis of the 2019 American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines for the management of rotator cuff injuries. Methods All studies cited in the 2019 AAOS clinical practice guidelines for the management of rotator cuff injuries were extracted and categorized. Extracted data included type of study, number of patients, level of evidence, journal of publication, impact factor, year of publication, country of origin, contributing authors, affiliated institutions, and significant findings. Data were analyzed to determine time from publication to implementation, level of evidence, and frequency of cited journals and authors. Results The studies cited in the guideline included 15,130 patients from 140 studies published between 1994 and 2018. The overall mean time from article publication to 2019 AAOS clinical practice guidelines was 4.76 ± 2.23 years. Of articles published in 2010 to 2019, 64 studies were cited in the strong recommendation strength subcategory, and 57 articles were cited in the moderate recommendation strength subcategory. Articles published in Journal of Shoulder & Elbow Surgery and Arthroscopy were cited most frequently. The most frequent authors were J. H. Oh, R. Z. Tashjian, S. H. Kim, N. Maffulli, and J. C. Yoo. Conclusions The 2019 AAOS CPG reference a diverse number of journals and authors, appearing to be impartial. Furthermore, prompt time from publication to implementation in the Guidelines indicates that it is possible to influence clinical guidelines with recent work. Clinical Relevance An analysis of the scientific research that forms the basis of the AAOS Clinical Practice Guidelines for the Management of Rotator Cuff Injuries can provide valuable information about the quality of the Guidelines.
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Steen‐Hansen C, Rothe C, Kjeldgaard LD, Lyngeraa TS, Lundstrøm LH, Lange KHW. Low volume proximal suprascapular nerve block after arthroscopic shoulder surgery - A randomised, controlled trial. Acta Anaesthesiol Scand 2022; 66:742-749. [PMID: 35332521 DOI: 10.1111/aas.14064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/09/2022] [Accepted: 03/22/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND A proximal suprascapular nerve block has been suggested as an alternative to an interscalene brachial plexus block after arthroscopic shoulder surgery. The aim of this randomised controlled trial was to compare the analgesic and opioid-sparing effect of a low volume proximal suprascapular nerve block with placebo in patients with moderate-to-severe pain after arthroscopic shoulder surgery. METHODS Patients with a VAS score equal to or above 50 during the first postoperative hour after planned arthroscopic shoulder surgery were included in the study. They were randomised to an ultrasound-guided proximal suprascapular nerve block with either 5 ml ropivacaine 7.5 mg/ml or 5 ml isotonic NaCl. Primary outcome was change in VAS score at rest from baseline to 30 min after the block procedure (T30). Secondary outcomes included total morphine consumption from 0-6 h after block procedure. RESULTS There was a significant difference in mean VAS reductions at T30 between the two groups favouring the ropivacaine group (-50.2 vs -26.8, p < .001). Total intravenous morphine consumption from 0-6 h after block procedure was significantly lower in the ropivacaine group compared to the placebo group (8.5 mg vs 18.5 mg, p < .01). CONCLUSION In this study, a proximal suprascapular nerve block with only 5 ml ropivacaine resulted in a substantial pain reduction and opioid-sparing effect in patients with VAS of 50 or more after arthroscopic shoulder surgery.
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Affiliation(s)
- Christian Steen‐Hansen
- Department of Anaesthesiology and Intensive Care Nordsjællands Hospital Hillerød Denmark
| | - Christian Rothe
- Department of Anaesthesiology and Intensive Care Nordsjællands Hospital Hillerød Denmark
| | - Line D. Kjeldgaard
- Department of Anaesthesiology and Intensive Care Holbæk Sygehus Holbæk Denmark
| | - Tobias S. Lyngeraa
- Department of Anaesthesiology and Intensive Care Nordsjællands Hospital Hillerød Denmark
| | - Lars H. Lundstrøm
- Department of Anaesthesiology and Intensive Care Nordsjællands Hospital Hillerød Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Kai H. W. Lange
- Department of Anaesthesiology and Intensive Care Nordsjællands Hospital Hillerød Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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Berton A, Longo UG, De Salvatore S, Sciotti G, Santamaria G, Piergentili I, De Marinis MG, Denaro V. A Historical Analysis of Randomized Controlled Trials in the Management of Pain in Rotator Cuff Tears. J Clin Med 2021; 10:jcm10184072. [PMID: 34575180 PMCID: PMC8470804 DOI: 10.3390/jcm10184072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 11/26/2022] Open
Abstract
The aim of this analysis was to assess the quality of reporting of randomized controlled trials (RCTs) relating to pain management in rotator cuff (RC) tears. This review evaluated the quality of the studies in the literature regarding this topic through the use of some factors and trends. The online databases used to search all RCTs on the topic of RC surgery were Medline, Scopus, CINAHL, EMBASE, and CENTRAL. This research was completed in September 2020. To assess the quality of reports, the Consolidated Standards of Reporting Trials (CONSORT) and the modified Coleman methodology score (MCMS) were used. From the research, 262 articles emerged. Finally, 79 studies were included in this historical analysis. There were no statistically significant changes in MCMS across trials that included or did not include a CONSORT diagram (p = 0.10). A statistically significant difference in MCMS was discovered between papers produced prior to 2009 and publications produced after 2015 (p = 0.03). There was no association between the number of checklist items for each article and the Coleman score. During the years there has been a significant increase in both quantity and quality of RCTs relating to pain in RC tears.
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Affiliation(s)
- Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (A.B.); (S.D.S.); (I.P.); (V.D.)
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (A.B.); (S.D.S.); (I.P.); (V.D.)
- Correspondence: ; Tel.: +39-062-2541-1613
| | - Sergio De Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (A.B.); (S.D.S.); (I.P.); (V.D.)
| | - Gaia Sciotti
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, 00128 Rome, Italy; (G.S.); (G.S.); (M.G.D.M.)
| | - Giulia Santamaria
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, 00128 Rome, Italy; (G.S.); (G.S.); (M.G.D.M.)
| | - Ilaria Piergentili
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (A.B.); (S.D.S.); (I.P.); (V.D.)
| | - Maria Grazia De Marinis
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, 00128 Rome, Italy; (G.S.); (G.S.); (M.G.D.M.)
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (A.B.); (S.D.S.); (I.P.); (V.D.)
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Kim JY, Kang MW, Lee HW, Noh KC. Suprascapular Nerve Block Is an Effective Pain Control Method in Patients Undergoing Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial. Orthop J Sports Med 2021; 9:2325967120970906. [PMID: 33553443 PMCID: PMC7841678 DOI: 10.1177/2325967120970906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/01/2020] [Indexed: 12/22/2022] Open
Abstract
Background Effective pain control in patients who have undergone arthroscopic rotator cuff surgery improves functional recovery and early mobilization. Interscalene blocks (ISBs), a widely used approach, are safe and provide fast pain relief; however, they are associated with complications. Another pain management strategy is the use of a suprascapular nerve block (SSNB). Hypothesis We hypothesized that indwelling SSNB catheters are a more effective pain control method than single-shot ISBs. We also hypothesized that indwelling SSNB catheters will reduce the level of rebound pain and the demand for opioid analgesics. Study Design Randomized controlled trial; Level of evidence, 1. Methods Included in this study were 93 patients who underwent arthroscopic rotator cuff surgery between May 2012 and January 2019. These patients were assigned to either the indwelling SSNB catheter group, the single-shot ISB group, or the control (sham/placebo) group (31 patients per group). Level of pain was measured with a visual analog scale (VAS; 0 to 10 [worst pain]) on the day of the operation. The preoperative VAS score was recorded at 6 AM on the day of operation, and the postoperative scores were recorded at 1, 8, and 16 hours after surgery and then every 8 hours until postoperative day 3. Results The VAS pain scores were lower in the SSNB and ISB groups than in the control group up to postoperative hour (POH) 8, with the most significant difference at POH 8. At POH 1 and POH 8, the mean VAS scores for each group were 2.29 and 1.74 (SSNB), 2.59 and 2.50 (ISB), and 3.42 and 4.48 (control), respectively. VAS scores in the SSNB and ISB groups were consistently <3, compared with a mean VAS score of 3.1 ± 1.58 in the control group (P < .001). Compared with the ISB group, the SSNB group had significantly fewer side effects such as rebound pain duration as well as lower VAS scores (P < .001). Conclusion VAS scores were the lowest in the indwelling SSNB catheter group, with the most pronounced between-group difference in VAS scores at POH 8. Severity and recurring frequency of pain were lower in the indwelling SSNB catheter group than in the single-shot ISB group.
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Affiliation(s)
- Jung Youn Kim
- Shoulder & Elbow Clinic, Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea
| | - Min Wook Kang
- Shoulder & Elbow Clinic, Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea
| | - Ho Won Lee
- Shoulder & Elbow Clinic, Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea
| | - Kyu Cheol Noh
- Shoulder & Elbow Clinic, Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea
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Lee JJ, Kim DY, Hwang JT, Song DK, Lee HN, Jang JS, Lee SS, Hwang SM, Moon SH, Shim JH. Dexmedetomidine combined with suprascapular nerve block and axillary nerve block has a synergistic effect on relieving postoperative pain after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2021; 29:4022-4031. [PMID: 32975624 PMCID: PMC7517062 DOI: 10.1007/s00167-020-06288-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/14/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Suprascapular nerve block (SSNB) is the most commonly used block for the relief of postoperative pain from arthroscopic rotator cuff repair and can be used in combination with axillary nerve block (ANB). Dexmedetomidine (DEX) is a type of alpha agonist that can elongate the duration of regional block. The aim of this study was to compare the effects of the use of dexmedetomidine combined with SSNB and ANB with those of the use of SSNB and ANB alone on postoperative pain, satisfaction, and pain-related cytokines within the first 48 h after arthroscopic rotator cuff repair. METHODS Forty patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled in this single-center, double-blinded randomized controlled trial study. Twenty patients were randomly allocated to group 1 and received ultrasound-guided SSNB and ANB using a mixture of 0.5 ml (50 μg) of DEX and 9.5 ml of 0.75% ropivacaine preemptively. The other 20 patients were allocated to group 2 and underwent ultrasound-guided SSNB and ANB alone using a mixture of 0.5 ml of normal saline and 9.5 ml of ropivacaine. The visual analog scale (VAS) for pain and patient satisfaction (SAT) scores were postoperatively checked within 48 h. The plasma interleukin (IL)-6, IL-8, IL-1β, cortisol, and serotonin levels were also postoperatively measured within 48 h. RESULTS Group 1 showed a significantly lower mean VAS (visual analog scale of pain) score 1, 3, 6, 12, 18 and 24 h after operation, and a significantly higher mean SAT (patient satisfaction) score 1, 3, 6, 12, 18, 24 and 36 h after the operation than group 2. Group 1 showed a significantly lower mean plasma IL-8 level 1 and 48 h after the operation, and a significantly lower mean IL-1β level 48 h after the operation than group 2. Group 1 showed a significantly lower mean plasma serotonin level 12 h after the operation than group 2. The mean timing of rebound pain in group 1 was significantly later than that in group 2 (36 h > 23 h, p = 0.007). Six patients each in groups 1 and 2 showed rebound pain. The others did not show rebound pain. CONCLUSIONS Ultrasound-guided SSNA and ANB with DEX during arthroscopic rotator cuff repair resulted in a significantly lower mean VAS score and a significantly higher mean SAT score within 48 h after the operation than SSNB and ANB alone. Additionally, SSNB and ANB with DEX tended to result in a later mean timing of rebound pain accompanied by significant changes in IL-8, IL-1β, and serotonin levels within 48 h after the operation. The present study could provide the basis for selecting objective parameters of postoperative pain in deciding the optimal use of medication for relieving pain. LEVEL OF EVIDENCE Level I. TRIAL REGISTRATION 2015-20, ClinicalTrials.gov Identifier: NCT04398589. IRB NUMBER 2015-20, Hallym University Chuncheon Sacred Heart Hospital.
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Affiliation(s)
- Jae Jun Lee
- Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Do-Young Kim
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea
| | - Jung-Taek Hwang
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea.
| | - Dong-Keun Song
- Department of Pharmacology, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Han Na Lee
- Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Ji Su Jang
- Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Sang-Soo Lee
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea
| | - Sung Mi Hwang
- Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Sung Hoon Moon
- Department of Orthopedic Surgery, Kangwon National University Hospital, Kangwon National University Medical College, Chuncheon-si, Republic of Korea
| | - Jae-Hoon Shim
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea
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A Historical Analysis of Randomized Controlled Trials in Rotator Cuff Tears. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186863. [PMID: 32962199 PMCID: PMC7558823 DOI: 10.3390/ijerph17186863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 12/16/2022]
Abstract
Background and objectives: Our research aimed to evaluate the quality of reporting of randomized controlled trials (RCTs) linked to rotator cuff (RC) tears. The present study analyzed factors connected to the quality of the RCTs and trends in the quality of reporting through time. Materials and Methods: The online databases used to search all RCTs on the topic of RC surgery completed until March 2020 were PubMed and Ovid (MEDLINE). The quality of reporting was evaluated using the modified Coleman methodology score (MCMS) and the consolidated standards of reporting trials (CONSORT). Results: The online search found 957 articles. Finally, 183 studies were included in the quantitative synthesis. A total of 97 (53%) of 183 studies had a level of evidence I and 86 (47%) of 183 studies had a level of evidence II, according to the Oxford Center of Evidence Based Medicine (EBM). A statistically significant difference in MCMS between articles written before 2010 and articles written after 2010 was found. Articles written after 2010 had, on average, the highest Coleman score. The average number of CONSORT checklist items for each article across all analyzed RCTs was 21.67. The 37 studies completed up to 2010 averaged a number of checklist items of 19.97 and the studies completed between 2011 and 2019 averaged a number of checklist items of 22.10. A statistically significant difference in the number of checklist items between articles written before 2010 and articles written after 2010 was found. Articles written after 2010 had on average more checklist items. However, low correlation (0.26) between the number of checklist items for each article and the respective Coleman score was found. On the other hand, articles with the CONSORT diagram had a significantly high Coleman score. Conclusions: An improvement in the quantity and quality of RCTs relating to RC surgery over the analyzed period was found.
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Hwang JT, Jang JS, Lee JJ, Song DK, Lee HN, Kim DY, Lee SS, Hwang SM, Kim YB, Lee S. Dexmedetomidine combined with interscalene brachial plexus block has a synergistic effect on relieving postoperative pain after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2020; 28:2343-2353. [PMID: 31773201 DOI: 10.1007/s00167-019-05799-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 11/12/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Interscalene brachial plexus block (ISB) is one of the most commonly used regional blocks in relieving postoperative pain after arthroscopic rotator cuff repair. Dexmedetomidine (DEX) is an alpha 2 agonist that can enhance the effect of regional blocks. The aim of this study was to compare the effects of DEX combined with ISB with ISB alone on postoperative pain, satisfaction, and pain-related cytokines within the first 48 h after arthroscopic rotator cuff repair. METHODS Fifty patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled in this single center, double-blinded randomized controlled trial study. Twenty-five patients were randomly allocated to group 1 and received ultrasound-guided ISB using a mixture of 1 ml (100 μg) of DEX and 8 ml of 0.75% ropivacaine preemptively. The other 25 patients were allocated to group 2 and underwent ultrasound-guided ISB alone using a mixture of 1 ml of normal saline and 8 ml of ropivacaine. The visual analog scale (VAS) for pain and patient satisfaction (SAT) scores were checked within 48 h postoperatively. The plasma interleukin (IL)-6, -8, -1β, cortisol, and substance P levels were also measured within 48 h, postoperatively. RESULTS Group 1 showed a significantly lower mean VAS score and a significantly higher mean SAT score than group 2 at 1, 3, 6, 12, and 18 h postoperatively. Compared with group 2, group 1 showed a significantly lower mean plasma IL-6 level at 1, 6, 12, and 48 h postoperatively and a significantly lower mean IL-8 level at 1, 6, 12, 24, and 48 h postoperatively. The mean timing of rebound pain in group 1 was significantly later than that in group 2 (12.7 h > 9.4 h, p = 0.006). CONCLUSIONS Ultrasound-guided ISB with DEX in arthroscopic rotator cuff repair led to a significantly lower mean VAS score and a significantly higher mean SAT score within 48 h postoperatively than ISB alone. In addition, ISB with DEX showed lower mean plasma IL-6 and IL-8 levels than ISB alone within 48 h postoperatively, with delayed rebound pain. LEVEL OF EVIDENCE I. TRIAL REGISTRATION 2013-112, ClinicalTrials.gov Identifier: NCT02766556.
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Affiliation(s)
- Jung-Taek Hwang
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Ji Su Jang
- Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea
| | - Jae Jun Lee
- Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea.
| | - Dong-Keun Song
- Department of Pharmacology, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Han Na Lee
- Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea
| | - Do-Young Kim
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Sang-Soo Lee
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Sung Mi Hwang
- Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 24253, Republic of Korea
| | - Yong-Been Kim
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Republic of Korea
| | - Sanghyeon Lee
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Republic of Korea
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Affiliation(s)
- M Heesen
- Kantonsspital, Baden, Switzerland
| | - M Klimek
- Erasmus University Medical Centre, Rotterdam, the Netherlands
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13
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Abdallah FW. Methods matter: a reply. Anaesthesia 2020; 75:687. [DOI: 10.1111/anae.14988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Choi H, Roh K, Joo M, Hong SH. Continuous suprascapular nerve block compared with single-shot interscalene brachial plexus block for pain control after arthroscopic rotator cuff repair. Clinics (Sao Paulo) 2020; 75:e2026. [PMID: 33206761 PMCID: PMC7603171 DOI: 10.6061/clinics/2020/e2026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/21/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We compared the analgesic efficacy of a continuous suprascapular nerve block (C-SSNB) and a single-shot interscalene brachial plexus block (S-ISNB) for postoperative pain management in patients undergoing arthroscopic rotator cuff repair. METHODS A total of 118 patients undergoing arthroscopic rotator cuff repair were randomly allocated to the S-ISNB or C-SSNB groups. Postoperative pain was assessed using the visual analog scale (VAS) at 1, 2, 6, 12, and 24 h postoperatively. Supplemental analgesic use was recorded as total equianalgesic fentanyl consumption. RESULTS The C-SSNB group showed significantly higher VAS scores at 0-1 h and 1-2 h after the surgery than the S-ISNB group (4.9±2.2 versus 2.3±2.2; p<0.0001 and 4.8±2.1 versus 2.4±2.3; p<0.0001, respectively). The C-SSNB group showed significantly lower VAS scores at 6-12 h after the surgery than the S-ISNB group (4.1±1.8 versus. 5.0±2.5; p=0.031). The C-SSNB group required significantly higher doses of total equianalgesic fentanyl in the post-anesthesia care unit than the S-ISNB group (53.66±44.95 versus 5.93±18.25; p<0.0001). Total equianalgesic fentanyl in the ward and total equianalgesic fentanyl throughout the hospital period were similar between the groups (145.99±152.60 versus 206.13±178.79; p=0.052 and 199.72±165.50 versus 212.15±180.09; p=0.697, respectively). CONCLUSION C-SSNB was more effective than S-ISNB at 6-12 h after the surgery for postoperative analgesia after arthroscopic rotator cuff repair.
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Affiliation(s)
- Hoon Choi
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Kyungmoon Roh
- Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Mina Joo
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Sang Hyun Hong
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Korea
- *Corresponding author. E-mail:
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Cho N, Kang RS, McCartney CJL, Pawa A, Costache I, Rose P, Abdallah FW. Analgesic benefits and clinical role of the posterior suprascapular nerve block in shoulder surgery: a systematic review, meta-analysis and trial sequential analysis. Anaesthesia 2019; 75:386-394. [PMID: 31583679 DOI: 10.1111/anae.14858] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2019] [Indexed: 11/28/2022]
Abstract
The posterior suprascapular nerve block has been proposed as an analgesic alternative for shoulder surgery based on the publication of several comparisons with interscalene block that failed to detect differences in analgesic outcomes. However, quantification of the absolute treatment effect of suprascapular nerve block on its own, in comparison with no block (control), to corroborate the aforementioned conclusions has been lacking. This study examines the absolute analgesic efficacy of suprascapular nerve block compared with control for shoulder surgery. We systematically sought electronic databases for studies comparing suprascapular nerve block with control. The primary outcomes included postoperative 24-h cumulative oral morphine consumption and the difference in area under the curve for 24-h pooled pain scores. Secondary outcomes included the incidence of opioid-related side-effects (postoperative nausea and vomiting) and patient satisfaction. Data were pooled using random-effects modelling. Ten studies (700 patients) were analysed; all studies examined landmark-guided posterior suprascapular nerve block performed in the suprascapular fossa. Suprascapular nerve block was statistically but not clinically superior to control for postoperative 24-h cumulative oral morphine consumption, with a weighted mean difference (99%CI) of 11.41 mg (-21.28 to -1.54; p = 0.003). Suprascapular nerve block was also statistically but not clinically superior to control for area under the curve of pain scores, with a mean difference of 1.01 cm.h. Nonetheless, suprascapular nerve block reduced the odds of postoperative nausea and vomiting and improved patient satisfaction. This review suggests that the landmark-guided posterior suprascapular nerve block does not provide clinically important analgesic benefits for shoulder surgery. Investigation of other interscalene block alternatives is warranted.
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Affiliation(s)
- N Cho
- Department of Anesthesiology and Pain Medicine, University of Ottowa, ON, Canada
| | - R S Kang
- Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| | - C J L McCartney
- Department of Anesthesiology and Pain Medicine, University of Ottowa, ON, Canada
| | - A Pawa
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - I Costache
- Department of Anesthesiology and Pain Medicine, University of Ottowa, ON, Canada
| | - P Rose
- Department of Anesthesiology and Pain Medicine, University of Ottowa, ON, Canada
| | - F W Abdallah
- Department of Anesthesiology and Pain Medicine, University of Ottowa, ON, Canada
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Toma O, Persoons B, Pogatzki-Zahn E, Van de Velde M, Joshi GP. PROSPECT guideline for rotator cuff repair surgery: systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2019; 74:1320-1331. [PMID: 31392721 PMCID: PMC6771830 DOI: 10.1111/anae.14796] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2019] [Indexed: 12/28/2022]
Abstract
Rotator cuff repair can be associated with significant and difficult to treat postoperative pain. We aimed to evaluate the available literature and develop recommendations for optimal pain management after rotator cuff repair. A systematic review using procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in English from 1 January 2006 to 15 April 2019 assessing postoperative pain after rotator cuff repair using analgesic, anaesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane Databases. Out of 322 eligible studies identified, 59 randomised controlled trials and one systematic review met the inclusion criteria. Pre‐operative and intra‐operative interventions that improved postoperative pain were paracetamol, cyclo‐oxygenase‐2 inhibitors, intravenous dexamethasone, regional analgesia techniques including interscalene block or suprascapular nerve block (with or without axillary nerve block) and arthroscopic surgical technique. Limited evidence was found for pre‐operative gabapentin, perineural adjuncts (opioids, glucocorticoids, or α‐2‐adrenoceptor agonists added to the local anaesthetic solution) or postoperative transcutaneous electrical nerve stimulation. Inconsistent evidence was found for subacromial/intra‐articular injection, and for surgical technique‐linked interventions, such as platelet‐rich plasma. No evidence was found for stellate ganglion block, cervical epidural block, specific postoperative rehabilitation protocols or postoperative compressive cryotherapy. The analgesic regimen for rotator cuff repair should include an arthroscopic approach, paracetamol, non‐steroidal anti‐inflammatory drugs, dexamethasone and a regional analgesic technique (either interscalene block or suprascapular nerve block with or without axillary nerve block), with opioids as rescue analgesics. Further randomised controlled trials are required to confirm the influence of the recommended analgesic regimen on postoperative pain relief.
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Affiliation(s)
- O Toma
- Institute for Anaesthesiology, Spital STS AG, Thun, Switzerland.,University of East Anglia, Norwich, UK
| | - B Persoons
- Department of Cardiovascular Sciences, Section Anaesthesiology, KU Leuven and University Hospital Leuven, Belgium
| | - E Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care, and Pain Medicine, University Hospital Münster, Germany
| | - M Van de Velde
- Department of Cardiovascular Sciences, Section Anaesthesiology, KU Leuven and University Hospital Leuven, Belgium
| | - G P Joshi
- Department of Anaesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Laumonerie P, Blasco L, Tibbo ME, Panagiotis K, Fernandes O, Lauwers F, Bonnevialle N, Mansat P, Ohl X. Ultrasound-Guided Versus Landmark-Based Approach to the Distal Suprascapular Nerve Block: A Comparative Cadaveric Study. Arthroscopy 2019; 35:2274-2281. [PMID: 31350084 DOI: 10.1016/j.arthro.2019.02.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 02/21/2019] [Accepted: 02/28/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the accuracy of distal suprascapular nerve (dSSN) blockade performed with the use of ultrasound-guided regional anesthesia (USRA) versus with a landmark-based approach (LBA). A secondary aim was to describe the anatomic features of the sensory branches of the dSSN. METHODS USRA and LBA were performed in 15 shoulders each from 15 cadavers (total of 30 shoulders). Then, 10 mL of methylene blue‒infused ropivacaine 0.75% was injected into the dSSN. Simultaneously, 2.5 mL of red latex solution was injected to identify the position of the needle tip. The division and distribution of the sensory branches originating from the SSN were described. RESULTS The tip of the needle was identified at 1.3 cm (range, 0-5.2 cm) and 1.5 cm (range, 0-4.5 cm) with USRA and the LBA, respectively (P = .90). Staining diffused past the origin of the most proximal sensory branch in 27 cases. The most proximal sensory branch arose 2.5 cm from the suprascapular notch. Among the 3 failures that occurred in the USRA group, the sensory branches also failed to be marked. All 30 dSSNs gave off 3 sensory branches, which innervated the posterior glenohumeral capsule, the subacromial bursa, and the coracoclavicular and acromioclavicular ligaments. CONCLUSIONS An LBA is as reliable and accurate as US guidance for anesthetic blockade of the dSSN. Marking of the suprascapular nerve must be proximal to the suprascapular notch to involve the 3 sensory branches in the anesthetic blockade. CLINICAL RELEVANCE The present study demonstrates that a landmark-based approach to anesthetic blockade of the distal suprascapular nerve is accurate and can be performed by orthopaedic surgeons lacking experience in ultrasound-guided anesthetic techniques.
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Affiliation(s)
- Pierre Laumonerie
- Anatomy Laboratory, Paul Sabatier-Toulouse III University, Toulouse, France; Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France.
| | - Laurent Blasco
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - Olivier Fernandes
- Department of Anesthesiology, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Frederic Lauwers
- Anatomy Laboratory, Paul Sabatier-Toulouse III University, Toulouse, France
| | - Nicolas Bonnevialle
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Pierre Mansat
- Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Xavier Ohl
- Department of Orthopaedic Surgery, Centre Hospitalier Universitaire de Reims, Reims, France
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Kay J, Memon M, Hu T, Simunovic N, Duong A, Paul J, Athwal G, Ayeni OR. Suprascapular Nerve Blockade for Postoperative Pain Control After Arthroscopic Shoulder Surgery: A Systematic Review and Meta-analysis. Orthop J Sports Med 2018; 6:2325967118815859. [PMID: 30627589 PMCID: PMC6311591 DOI: 10.1177/2325967118815859] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Regional nerve blocks are commonly used to manage postoperative pain after arthroscopic shoulder procedures. The interscalene brachial plexus block (ISB) is commonly used; however, because of the reported side effects of ISB, the use of a suprascapular nerve block (SSNB) has been described as an alternative strategy with fewer reported side effects. Purpose: To examine the efficacy of SSNB for pain control after shoulder arthroscopy compared with ISB as well as anesthesia without a nerve block. Study Design: Systematic review; Level of evidence, 1. Methods: Three databases (PubMed, MEDLINE, and EMBASE) were searched on April 20, 2018, to systematically identify and screen the literature for randomized controlled trials (RCTs). A meta-analysis of standard mean differences (SMDs) was performed to pool the estimated effects of the nerve blocks. Results: The search identified 14 RCTs that included 1382 patients, with a mean age of 54 years (SD, 13 years). The mean follow-up time was 3 days (range, 24 hours to 6 weeks). Postoperative pain control was significantly more effective in the SSNB groups compared with the control groups within 1 hour (SMD, –0.76; 95% CI, –1.45 to –0.07; P = .03) and 4 to 6 hours (SMD, –0.81; 95% CI, –1.53 to –0.09; P = .03) postoperatively. However, pain control was significantly less effective in the SSNB groups compared with ISB within 1 hour (SMD, 0.87; 95% CI, 0.28 to 1.46; P = .004). No major complications were noted in the SSNB groups, and minor complications such as hoarseness and prolonged motor block were significantly less common for SSNB compared with ISB. Conclusion: Although not more efficacious than ISB in terms of pain control for patients undergoing shoulder arthroscopy, SSNB provides significantly improved pain control in comparison with analgesia without a nerve block. Moreover, few major and minor complications are associated with SSNB reported across the literature.
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Affiliation(s)
- Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Muzammil Memon
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Hu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Duong
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - James Paul
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - George Athwal
- Roth McFarlane Hand and Upper Limb Center, St Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Rasmussen JK, Nikolajsen L, Bjørnholdt KT. Acute postoperative pain after arthroscopic rotator cuff surgery: A review of methods of pain assessment. SICOT J 2018; 4:49. [PMID: 30465647 PMCID: PMC6250077 DOI: 10.1051/sicotj/2018042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 08/10/2018] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Pain can be severe during the first days after arthroscopic surgery, and acute pain is an important outcome in clinical trials of surgical technique or anaesthetic strategy. A standardized, validated method of assessing acute postoperative pain would improve the quality of clinical studies, and facilitate systematic reviews and meta-analyses. A step on the way towards this standard is to investigate the methods most commonly used in recent literature. METHODS PubMed and CINAHL databases were searched, including studies of arthroscopic rotator cuff surgery with a primary pain-related outcome during the first postoperative week, published in English from 2012 to 2017. RESULTS A total of 47 studies were included, all measuring pain intensity using a pain rating scale. Most frequently used was the visual analogue scale using the anchors "no pain" and "worst pain imaginable", with recordings at 1, 2, 4, 6, 8, 12, and 24 hours postoperatively. A total of 34 studies recorded analgesic consumption, usually as average cumulated consumption in mg. Time to first analgesic request or first pain were recorded in 11 studies, and 4 different starting points were used. DISCUSSION This review describes the currently most common methods of assessing acute postoperative pain in clinical trials of arthroscopic shoulder surgery involving rotator cuff repair, and the large variety of methods applied. Based on this study and international guidelines, several recommendations on how to measure and report postoperative pain outcomes in future trials are proposed.
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Affiliation(s)
| | - Lone Nikolajsen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Research, C319, Palle Juul Jensens Boulevard 99, Aarhus, Denmark
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Ko SH, Cho SD, Lee CC, Choi JK, Kim HW, Park SJ, Bae MH, Cha JR. Comparison of Arthroscopically Guided Suprascapular Nerve Block and Blinded Axillary Nerve Block vs. Blinded Suprascapular Nerve Block in Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial. Clin Orthop Surg 2017; 9:340-347. [PMID: 28861202 PMCID: PMC5567030 DOI: 10.4055/cios.2017.9.3.340] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 05/05/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare the results of arthroscopically guided suprascapular nerve block (SSNB) and blinded axillary nerve block with those of blinded SSNB in terms of postoperative pain and satisfaction within the first 48 hours after arthroscopic rotator cuff repair. METHODS Forty patients who underwent arthroscopic rotator cuff repair for medium-sized full thickness rotator cuff tears were included in this study. Among them, 20 patients were randomly assigned to group 1 and preemptively underwent blinded SSNB and axillary nerve block of 10 mL 0.25% ropivacaine and received arthroscopically guided SSNB with 10 mL of 0.25% ropivacaine. The other 20 patients were assigned to group 2 and received blinded SSNB with 10 mL of 0.25% ropivacaine. Visual analog scale (VAS) score for pain and patient satisfaction score were assessed 4, 8, 12, 24, 36, and 48 hours postoperatively. RESULTS The mean VAS score for pain was significantly lower 4, 8, 12, 24, 36, and 48 hours postoperatively in group 1 (group 1 vs. group 2; 5.2 vs. 7.4, 4.1 vs. 6.1, 3.0 vs. 5.1, 2.1 vs. 4.2, 0.9 vs. 3.9, and 1.3 vs. 3.3, respectively). The mean patient satisfaction score was significantly higher at postoperative 4, 8, 12, 24, 36, and 48 hours in group 1 (group 1 vs. group 2; 6.7 vs. 3.9, 7.4 vs. 5.1, 8.8 vs. 5.9, 9.2 vs. 6.7, 9.5 vs. 6.9, and 9.0 vs. 7.2, respectively). CONCLUSIONS Arthroscopically guided SSNB and blinded axillary nerve block in arthroscopic rotator cuff repair for medium-sized rotator cuff tears provided more improvement in VAS for pain and greater patient satisfaction in the first 48 postoperative hours than blinded SSNB.
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Affiliation(s)
- Sang Hun Ko
- Department of Orthopedics Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sung Do Cho
- Department of Orthopedics Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Chae Chil Lee
- Department of Orthopedics Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jang Kyu Choi
- Department of Orthopedics Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Han Wook Kim
- Department of Orthopedics Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seon Jae Park
- Department of Orthopedics Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Mun Hee Bae
- Department of Orthopedics Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jae Ryong Cha
- Department of Orthopedics Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Effects of arthroscopy-guided suprascapular nerve block combined with ultrasound-guided interscalene brachial plexus block for arthroscopic rotator cuff repair: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2017; 25:2121-2128. [PMID: 27311449 DOI: 10.1007/s00167-016-4198-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to compare the pain relieving effect of ultrasound-guided interscalene brachial plexus block (ISB) combined with arthroscopy-guided suprascapular nerve block (SSNB) with that of ultrasound-guided ISB alone within the first 48 h after arthroscopic rotator cuff repair. METHODS Forty-eight patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled. The 24 patients in group 1 received ultrasound-guided ISB and arthroscopy-guided SSNB; the remaining 24 patients in group 2 underwent ultrasound-guided ISB alone. Visual analogue scale pain score and patient satisfaction score were checked at 1, 3, 6, 12, 18, 24, and 48 h post-operatively. RESULTS Group 1 had a lower visual analogue scale pain score at 3, 6, 12, 18, 24, and 48 h post-operatively (1.7 < 2.6, 1.6 < 4.0, 3.5 < 5.8, 3.6 < 5.2, 3.2 < 4.2, 1.3 < 2.0), and a higher patient satisfaction score at 6, 12, 18, 24, and 36 h post-operatively than group 2 (7.8 > 6.0, 6.2 > 4.3, 6.4 > 5.1, 6.9 > 5.9, 7.9 > 7.1). Six patients in group 1 developed rebound pain twice, and the others in group 1 developed it once. All of the patients in group 2 had one rebound phenomenon each (p = 0.010). The mean timing of rebound pain in group 1 was later than that in group 2 (15.5 > 9.3 h, p < 0.001), and the mean size of rebound pain was smaller in group 1 than that in group 2 (2.5 > 4.0, p = 0.001). CONCLUSION Arthroscopy-guided SSNB combined with ultrasound-guided ISB resulted in lower visual analogue scale pain scores at 3-24 and 48 h post-operatively, and higher patient satisfaction scores at 6-36 h post-operatively with the attenuated rebound pain compared to scores in patients who received ultrasound-guided ISB alone after arthroscopic rotator cuff repair. The combined blocks may relieve post-operative pain more effectively than the single block within 48 h after arthroscopic cuff repair. LEVEL OF EVIDENCE Randomized controlled trial, Level I. ClinicalTrials.gov Identifier: NCT02424630.
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Park JY, Bang JY, Oh KS. Blind suprascapular and axillary nerve block for post-operative pain in arthroscopic rotator cuff surgery. Knee Surg Sports Traumatol Arthrosc 2016; 24:3877-3883. [PMID: 26733274 DOI: 10.1007/s00167-015-3902-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/26/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE The goal of the study was to evaluate the efficacy of additional axillary nerve block (ANB) with suprascapular nerve block (SSNB) and patient-controlled anaesthesia (PCA) with no device assistance after arthroscopic rotator cuff repair. The hypothesis is that patients with intravenous (IV) PCA and the blockade of the two main nerves (SSNB + ANB) experienced lesser pain than patients with IV PCA or IV PCA + SSNB. METHODS The 114 patients undergoing arthroscopic rotator cuff repair were allocated randomly to three groups as follows: group I, intravenous PCA pumps (only PCA); group II, IV PCA + SSNB using a blind technique (PCA + SSNB); and group III, IV PCA + SSNB + ANB using a blind technique (PCA + SSNB + ANB). Pain visual analogue scale (VAS) scores were evaluated at 1, 6, 12, 24, 36, and 48 post-operative hours. Furthermore, the degree of pain was compared according to cuff tear size. RESULTS The pain VAS score of group III was lower than that of the other two groups and was significantly lower at post-operative hours 1, 6, and 12. In addition, the larger cuff tear tended to be indicative of greater pain. However, all groups experienced rebound pain. CONCLUSION PCA + SSNB + ANB using a blind technique is a better pain control method than PCA + SSNB and only PCA during the initial 12 post-operative hours. PCA + SSNB + ANB is a cost-effective, time-saving, and easily performed method for post-operative pain control as an axis of multimodal pain control strategy. LEVEL OF EVIDENCE II.
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Affiliation(s)
| | - Jin-Young Bang
- Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea.
| | - Kyung-Soo Oh
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, South Korea
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Suprascapular Nerve Block Versus Interscalene Block as Analgesia After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Noninferiority Trial. Arthroscopy 2016; 32:2203-2209. [PMID: 27177436 DOI: 10.1016/j.arthro.2016.03.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 02/16/2016] [Accepted: 03/10/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the efficacy of suprascapular nerve block (SSB) and interscalene block (ISB) as postoperative analgesia within the first 24 hours after arthroscopic supraspinatus and/or infraspinatus tendon repair. METHODS A single-blind, randomized controlled study was performed between 2013 and 2014. The inclusion criteria were arthroscopic supraspinatus and/or infraspinatus tendon repair confirmed intraoperatively, with or without associated procedures, and informed consent. The exclusion criteria were a previously operated shoulder, repair of the subscapularis tendon, and an allergy to local anesthetics. ISB was performed under ultrasound guidance by an anesthesiologist, whereas SSB was performed based on specific anatomic landmarks by a surgeon. The primary evaluation criterion was mean shoulder pain score during the first postoperative 24 hours assessed on a visual analog scale by the patient. The secondary criteria were complications of locoregional anesthesia, the use of analgesics in the recovery room (the first 2 hours) until postoperative day 7, and pain (visual analog scale) during the first week. Forty-four patients were needed for this noninferiority study. An institutional review board approved the study. RESULTS Seventy-four patients were randomized, and 59 met the intraoperative inclusion criteria. Six patients were excluded (1 for pneumothorax after ISB, 1 for unsuccessful SSB, and 4 for incomplete questionnaires). None of the patients were lost to follow-up. There was no significant difference between the SSB and ISB groups in mean pain score for the first 24 hours (P = .92) or the first 7 days (P = .05). However, there was significantly less pain in the ISB group in the recovery room (P = .01). Consumption of analgesics was comparable between the groups, but the SSB group took significantly more morphine in the recovery room. CONCLUSIONS In this prospective, randomized controlled study, SSB was as effective as ISB for mean pain control within the first 24 hours but ISB was more effective in relieving pain in the recovery room after arthroscopic supraspinatus and/or infraspinatus tendon repair. LEVEL OF EVIDENCE Level I, therapeutic, randomized controlled study.
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Uquillas CA, Capogna BM, Rossy WH, Mahure SA, Rokito AS. Postoperative pain control after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2016; 25:1204-13. [PMID: 27079219 DOI: 10.1016/j.jse.2016.01.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/17/2016] [Accepted: 01/22/2016] [Indexed: 02/01/2023]
Abstract
Arthroscopic rotator cuff repair (ARCR) can provide excellent clinical results for patients who fail to respond to conservative management of symptomatic rotator cuff tears. ARCR, however, can be associated with severe postoperative pain and discomfort that requires adequate analgesia. As ARCR continues to shift toward being performed as an outpatient procedure, it is incumbent on physicians and ambulatory surgical centers to provide appropriate pain relief with minimal side effects to ensure rapid recovery and safe discharge. Although intravenous and oral opioids are the cornerstone of pain management after orthopedic procedures, they are associated with drowsiness, nausea, vomiting, and increased length of hospital stay. As health care reimbursements continue to become more intimately focused on quality, patient satisfaction, and minimizing of complications, the need for adequate pain control with minimal complications will continue to be a principal focus for providers and institutions alike. We present a review of alternative modalities for pain relief after ARCR, including cryotherapy, intralesional anesthesia, nerve blockade, indwelling continuous nerve block catheters, and multimodal anesthesia. In choosing among these modalities, physicians should consider patient- and system-based factors to allow the efficient delivery of analgesia that optimizes recovery and improves patient satisfaction.
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Affiliation(s)
- Carlos A Uquillas
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - Brian M Capogna
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - William H Rossy
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - Siddharth A Mahure
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA.
| | - Andrew S Rokito
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
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Polguj M, Rożniecki J, Sibiński M, Grzegorzewski A, Majos A, Topol M. The variable morphology of suprascapular nerve and vessels at suprascapular notch: a proposal for classification and its potential clinical implications. Knee Surg Sports Traumatol Arthrosc 2015; 23:1542-1548. [PMID: 24633009 PMCID: PMC4555201 DOI: 10.1007/s00167-014-2937-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 03/04/2014] [Indexed: 12/05/2022]
Abstract
PURPOSE The most common place for suprascapular nerve entrapment is the suprascapular notch. The aim of the study was to determine the morphological variation of the location of the suprascapular nerve, artery and vein, and measure the reduction in size of the suprascapular opening in each type of the passage. METHODS A total of 106 human formalin-fixed cadaveric shoulders were included in the study. After dissection of the suprascapular region, the topography of the suprascapular nerve, artery and vein was evaluated. Additionally, the area of the suprascapular opening was measured using professional image analysis software. RESULTS Four arrangements of the suprascapular vein, artery and nerve were distinguished with regard to the superior transverse scapular ligament: type I (61.3 %) (suprascapular artery was running above ligament, while suprascapular vein and nerve below it), type II (17 %) (both vessels pass above ligament, while nerve passes under it), type III (12.3 %) (suprascapular vessels and nerve lie under ligament) and type IV (9.4 %), which comprises the other variants of these structures. Statistically significant differences regarding the suprascapular opening were observed between the specimens with types II and III. Anterior coracoscapular ligaments were present in 55 from 106 shoulders. CONCLUSION The morphological variations described in this study are necessary to better understand the possible anatomical conditions which may promote suprascapular nerve entrapment (especially type III). They may be useful during open and endoscopic procedures at the suprascapular notch to prevent such complications as unexpected bleeding.
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Affiliation(s)
- Michał Polguj
- Department of Angiology, Medical University of Łódź, Narutowicza 60, 90-136, Łódź, Poland.
| | - Jacek Rożniecki
- Department of Neurology, Medical University of Łódź, Łódź, Poland
| | - Marcin Sibiński
- Clinic of Orthopedic and Pediatric Orthopedics, Medical University of Łódź, Łódź, Poland
| | - Andrzej Grzegorzewski
- Clinic of Orthopedic and Pediatric Orthopedics, Medical University of Łódź, Łódź, Poland
| | - Agata Majos
- Department of Radiology, Medical University of Łódź, Łódź, Poland
| | - Mirosław Topol
- Department of Normal and Clinical Anatomy, Medical University of Łódź, Łódź, Poland
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Lee JJ, Kim DY, Hwang JT, Lee SS, Hwang SM, Kim GH, Jo YG. Effect of ultrasonographically guided axillary nerve block combined with suprascapular nerve block in arthroscopic rotator cuff repair: a randomized controlled trial. Arthroscopy 2014; 30:906-14. [PMID: 24880194 DOI: 10.1016/j.arthro.2014.03.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 03/11/2014] [Accepted: 03/20/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to compare the results of ultrasonographically guided axillary nerve block (ANB) combined with suprascapular nerve block (SSNB) with those of SSNB alone on postoperative pain and satisfaction within the first 48 hours after arthroscopic rotator cuff repair. METHODS Forty-two patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled in this study. Among them, 21 patients were randomly allocated to group 1 and received both SSNB and ANB with 10 mL ropivacaine. The other 21 patients were allocated to group 2 and received SSNB with 10 mL 0.75% ropivacaine and ANB with 10 mL saline. Visual analog scale (VAS) pain score, patient satisfaction (SAT), and lateral pain index (LPI) was checked at 1, 3, 6, 12, 18, 24, 36, and 48 hours postoperatively. RESULTS Group 1 showed a significantly lower mean VAS score at postoperative 1, 3, 6, 12, 18, and 24 hours compared with group 2 (5.1 < 7.6, 4.4 < 6.3, 3.7 < 5.3, 3.2 < 4.5, 2.7 < 4.0, and 2.7 < 3.4, respectively). A significantly high mean SAT and low mean LPI was observed in group 1 at postoperative 1, 3, 6, 12, 18, 24, and 36 hours (4.9 > 2.4, 5.9 > 3.7, 6.3 > 5.0, 6.8 > 5.7, 7.3 > 6.2, 7.5 > 6.6, and 7.7 > 7.0, respectively), (1.1 < 3.0, 0.8 < 2.5, 0.7 < 2.0, 0.7 < 1.6, 0.6 < 1.3, 0.6 < 1.0, and 0.4 < 0.7, respectively). The frequency of rebound pain decreased in group 1 compared with group 2 (P = .032). In addition, rebound phenomenon showed a correlation with ANB on univariate logistic regression (P = .034; odds ratio, 0.246). CONCLUSIONS Ultrasonographically guided ANB combined with SSNB in arthroscopic rotator cuff repair showed an improved mean VAS in the first 24 hours after surgery compared with SSNB alone. The mean SAT and LPI of the combined blocks were better than those of the single block within the first 36 hours. Ultrasonographically guided ANB combined with SSNB also decreased the rebound phenomenon. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Jae Jun Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Do-Young Kim
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea; Institute for Skeletal Aging and Orthopedic Surgery, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Jung-Taek Hwang
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea; Institute for Skeletal Aging and Orthopedic Surgery, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea.
| | - Sang-Soo Lee
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea; Institute for Skeletal Aging and Orthopedic Surgery, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Sung Mi Hwang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Gi Ho Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Yoon-Geol Jo
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea
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