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Huang YY, Ng YT, Chiu CH, Chuang CA, Sheu H, Yang CP, Tang HC. Addition of preoperative ultrasound-guided suprascapular nerve block and axillary nerve block to parecoxib is more effective in early postoperative pain control following arthroscopic rotator cuff repair: a prospective randomized controlled study. Arthroscopy 2024:S0749-8063(24)00166-X. [PMID: 38447626 DOI: 10.1016/j.arthro.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/18/2024] [Accepted: 02/24/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE The purpose of the study was to prospectively compare the pain intensity and patient-reported outcomes (PROs) following arthroscopic rotator cuff repair (ARCR) between patients who received ultrasound-guided suprascapular nerve block (SSNB) and axillary nerve block (ANB) as well as preincisional parecoxib and patients who received preincisional parecoxib only. METHODS Sixty-one patients receiving ARCR between March 2020 and March 2021 were prospectively enrolled. They were randomly assigned to the peripheral nerve block group (group N, n=30) or control group (group C, n=31). Two patients from group C were excluded because of miscommunication. All patients were administered parecoxib 40 mg intravenously prior to induction of anesthesia. In group N, SSNB/ANB were performed after general anesthesia while no nerve block was performed in group C. The pain intensity was compared before the surgery, as well as immediately, 24 hours and 2 weeks after the surgery. PROs, including Oxford shoulder score, University of California-Los Angeles shoulder score and Single Assessment Numeric Evaluation score, were compared before and 6 months after the surgery. RESULTS The resting pain numerical rating scale (NRS) was significantly lower in group N (4.9 ± 3.1 vs. 7.6 ± 2.5, p<0.001) immediately after the surgery, but no difference was noted 24 hours after the surgery. The resting pain NRS 2 weeks after the surgery was significantly lower in group N (1.4 ± 1.6 vs. 2.7 ± 2.7, p=0.03), but the movement-evoked pain and night pain were similar. All PROs significantly improved 6 months after the surgery in both groups, but there was no difference between the 2 groups. CONCLUSION Addition of preoperative ultrasound-guided SSNB and ANB to parecoxib offered better resting pain control immediately and 2 weeks after ARCR, but there was no benefit for PROs 6 months after the surgery. LEVEL OF EVIDENCE Level 2 prospective randomized controlled trial.
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Affiliation(s)
- Yu-Yi Huang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan, No.222, Maijin Rd., Anle Dist., Keelung City 204, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan, No.259, Wunhua 1(st) Rd., Guishan Dist., Taoyuan City 333, Taiwan
| | - Yuet-Tong Ng
- Department of Anesthesiology, Chang Gung Memorial Hospital, Keelung, Taiwan, No.222, Maijin Rd., Anle Dist., Keelung City 204, Taiwan
| | - Chih-Hao Chiu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, No.259, Wunhua 1(st) Rd., Guishan Dist., Taoyuan City 333, Taiwan; Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, No. 5, Fusing St., Gueishan, Taoyuan City 333, Taiwan
| | - Chieh-An Chuang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, No.259, Wunhua 1(st) Rd., Guishan Dist., Taoyuan City 333, Taiwan; Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, No. 5, Fusing St., Gueishan, Taoyuan City 333, Taiwan
| | - Huan Sheu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, No.259, Wunhua 1(st) Rd., Guishan Dist., Taoyuan City 333, Taiwan; Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, No. 5, Fusing St., Gueishan, Taoyuan City 333, Taiwan
| | - Cheng-Pang Yang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, No.259, Wunhua 1(st) Rd., Guishan Dist., Taoyuan City 333, Taiwan; Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, No. 5, Fusing St., Gueishan, Taoyuan City 333, Taiwan
| | - Hao-Che Tang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan, No.222, Maijin Rd., Anle Dist., Keelung City 204, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan, No.259, Wunhua 1(st) Rd., Guishan Dist., Taoyuan City 333, Taiwan.
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Feltri P, Monteleone AS, Audigé L, Marbach F, Filardo G, Candrian C. Patients with rotator cuff tears present a psychological impairment, not only a functional deficit: a systematic review. INTERNATIONAL ORTHOPAEDICS 2024; 48:169-181. [PMID: 37673844 DOI: 10.1007/s00264-023-05952-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/20/2023] [Indexed: 09/08/2023]
Abstract
INTRODUCTION Psychological factors impact patients with rotator cuff tears (RCT) in terms of pain level, shoulder function, sleep disturbance, and quality of life (QoL). The aim of this study was to quantify the prevalence of psychological factors in those patients, evaluate their influence on patient-reported outcomes (PROMs), and assess the possible improvement with surgical treatment. METHODS The literature search was performed on PubMed, Web of Science, Wiley Cochrane Library up to January, 2023. INCLUSION CRITERIA RCT treated with arthroscopic rotator cuff reconstruction (ARCR), description of psychological variables evaluated with validated questionnaires, descriptions of PROMs. RESULTS Thirty-nine studies included 7021 patients. Depression was found in eight studies (19.2%), anxiety in 6 (13.0%), sleep disturbance in seven (71.3%), and distress in three studies (26.4%). Studies evaluating the relationship between psychological impairment and pain documented more pain and impaired shoulder function before and after ARCR in patients with altered psychological status. DISCUSSION An impaired psychological status has an important impact on patients' perception of their disease. RCT patients with psychological alterations often experience more pain and reduced shoulder function, thus having worse QoL. CONCLUSION This study underlines that psychological impairment largely affects RCT patient condition and treatment outcome, which underlines the importance of a multidisciplinary biopsychosocial intervention to achieve better results.
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Affiliation(s)
- Pietro Feltri
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900, Lugano, Switzerland
| | | | - Laurent Audigé
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland
- Research and Development, Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Francesco Marbach
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900, Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Chen W, Sun JN, Hu ZH, Zhang Y, Chen XY, Feng S. Early Stage Versus Late Stage Periarticular Injection during Unicompartmental Knee Arthroplasty for Postoperative Pain Relief: A Randomized Controlled Trial. J Knee Surg 2022; 35:1425-1433. [PMID: 33618395 DOI: 10.1055/s-0041-1723982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Controlling postoperative pain after unicompartmental knee arthroplasty (UKA) is essential to improve patient satisfaction and promote early recovery. The purpose of this study was to investigate the difference in clinical efficacy between early and late stage periarticular injection during UKA for postoperative pain relief. Eighty-four patients meeting the inclusion and exclusion criteria were randomly divided into the early stage periarticular injection group and late stage periarticular injection group by using a random number tables method. The difference between the two groups was that the early stage periarticular injection group received superficial injection before the joint incision, while the late stage periarticular injection group received superficial injection after implantation of the prosthesis. Deep injection and other perioperative conditions of the two groups were controlled identically. The primary outcome of the study was the recovery room immediate visual analog scale (VAS) at rest. The secondary outcomes were the postoperative VAS (at rest) at 3, 6, 9, 12, 18, 24, 48, 72, 96, and 120 hours, drug dosage of rescue analgesia, range of motion (ROM), and complications. The recovery room immediate VAS (at rest) in the early stage periarticular injection group was significantly lower than that of the late stage periarticular injection group (21 ± 24 vs. 32 ± 34 mm, p = 0.018), the average difference of the VAS reached the minimal clinically important difference. No statistically significant difference in postoperative drug dosage of rescue analgesia, ROM, and complications. Preemptive analgesia combined with the early stage periarticular injection can better alleviate postoperative pain than the late stage periarticular injection.
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Affiliation(s)
- Wang Chen
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jian-Ning Sun
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.,Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zheng-Hao Hu
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yu Zhang
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiang-Yang Chen
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shuo Feng
- Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
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Clinical and structural outcome of intra-articular steroid injection for early stiffness after arthroscopic rotator cuff repair. INTERNATIONAL ORTHOPAEDICS 2022; 46:563-571. [DOI: 10.1007/s00264-021-05288-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/12/2021] [Indexed: 11/26/2022]
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Wang Y, Liu Y, Liu J, Wang M, Wang Y. Coadministration of Curcumin and Hydromorphone Hydrochloride Alleviates Postoperative Pain in Rats. Biol Pharm Bull 2022; 45:27-33. [PMID: 34980778 DOI: 10.1248/bpb.b21-00434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study aimed to explore the effect of curcumin and hydromorphone hydrochloride (HH) cotreatment on postoperative pain in rats. An incision + formaldehyde-induced pain rat model was established. Rats were treated with vehicle, curcumin, HH, or curcumin + HH. Paw mechanical withdrawal threshold and thermal withdrawal latency were measured at 1 d before surgery as well as 1 , 2 h, 1 , 3 , and 7 d after surgery to assess pain sensitivity. The L4-6 region of the spinal cord was collected from each rat at 2 h, 1 , 3 , and 7 d after surgery. Western blot analysis and immunohistochemical staining were carried out to detect the protein expression of pain-related genes. Quantitative real-time PCR and enzyme-linked immunosorbent assay were conducted to measure the expression and production of proinflammatory mediators. Compared with other groups, Curcumin + HH significantly reduced pain sensitivity in the model rats. Mechanistically, curcumin + HH suppressed protein expression of stromal cell-derived factor-1 (SDF-1), CXC chemokine receptor 4 (CXCR4), p-Akt, and c-fos while enhancing protein expression of nerve growth factor (NGF) in the dorsal root ganglia (DRG) of model rats. Curcumin + HH inhibited the expression and production of interleukin 1β (IL-1β), cyclooxygenase-2 (COX-2), tumor necrosis factor α (TNF-α), and p65 nuclear factor kappa B (NF-κB) in the DRG. Coadministration of curcumin and HH alleviates incision + formaldehyde-induced pain in rats, possibly by suppressing the SDF-1/CXCR4 pathway and the production of proinflammatory mediators. Our results provide curcumin and HH cotreatment as a promising therapeutic strategy in the management of postoperative pain.
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Affiliation(s)
- Yihan Wang
- Department of anesthesiology, Lanzhou University Second Hospital
| | - Yang Liu
- Department of anesthesiology, Lanzhou University Second Hospital
| | - Jieting Liu
- Department of anesthesiology, Lanzhou University Second Hospital
| | - Min Wang
- Department of anesthesiology, Lanzhou University Second Hospital
| | - Yingbin Wang
- Department of anesthesiology, Lanzhou University Second Hospital
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Shanthanna H, Czuczman M, Moisiuk P, O'Hare T, Khan M, Forero M, Davis K, Moro J, Vanniyasingam T, Foster G, Thabane L, Alolabi B. Erector spinae plane block vs. peri-articular injection for pain control after arthroscopic shoulder surgery: a randomised controlled trial. Anaesthesia 2021; 77:301-310. [PMID: 34861745 DOI: 10.1111/anae.15625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 11/28/2022]
Abstract
Interscalene brachial plexus block is the standard regional analgesic technique for shoulder surgery. Given its adverse effects, alternative techniques have been explored. Reports suggest that the erector spinae plane block may potentially provide effective analgesia following shoulder surgery. However, its analgesic efficacy for shoulder surgery compared with placebo or local anaesthetic infiltration has never been established. We conducted a randomised controlled trial to compare the analgesic efficacy of pre-operative T2 erector spinae plane block with peri-articular infiltration at the end of surgery. Sixty-two patients undergoing arthroscopic shoulder repair were randomly assigned to receive active erector spinae plane block with saline peri-articular injection (n = 31) or active peri-articular injection with saline erector spinae plane block (n = 31) in a blinded double-dummy design. Primary outcome was resting pain score in recovery. Secondary outcomes included pain scores with movement; opioid use; patient satisfaction; adverse effects in hospital; and outcomes at 24 h and 1 month. There was no difference in pain scores in recovery, with a median difference (95%CI) of 0.6 (-1.9-3.1), p = 0.65. Median postoperative oral morphine equivalent utilisation was significantly higher in the erector spinae plane group (21 mg vs. 12 mg; p = 0.028). Itching was observed in 10% of patients who received erector spinae plane block and there was no difference in the incidence of significant nausea and vomiting. Patient satisfaction scores, and pain scores and opioid use at 24 h were similar. At 1 month, six (peri-articular injection) and eight (erector spinae plane block) patients reported persistent pain. Erector spinae plane block was not superior to peri-articular injection for arthroscopic shoulder surgery.
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Affiliation(s)
- H Shanthanna
- Department of Anesthesia, St Joseph's Health Care, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - M Czuczman
- Department of Anesthesia, St Joseph's Health Care, McMaster University, Hamilton, ON, Canada
| | - P Moisiuk
- Department of Anesthesia, St Joseph's Health Care, McMaster University, Hamilton, ON, Canada
| | - T O'Hare
- Department of Anesthesia, St Joseph's Health Care, McMaster University, Hamilton, ON, Canada
| | - M Khan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Department of Surgery, Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - M Forero
- Department of Anesthesia, St Joseph's Health Care, McMaster University, Hamilton, ON, Canada
| | - K Davis
- Department of Anesthesia, St Joseph's Health Care, McMaster University, Hamilton, ON, Canada
| | - J Moro
- Department of Surgery, Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - T Vanniyasingam
- Department of Anesthesia, St Joseph's Health Care, McMaster University, Hamilton, ON, Canada
| | - G Foster
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Research Institute of St Joes, Hamilton, ON, Canada
| | - L Thabane
- Department of Anesthesia, St Joseph's Health Care, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - B Alolabi
- Department of Surgery, Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
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Maurya I, Garg R, Jain VK, Iyengar KP, Vaishya R. Perioperative anaesthetic considerations for rotator cuff repair surgeries: A current concept review. J Clin Orthop Trauma 2021; 17:65-71. [PMID: 33717972 PMCID: PMC7920097 DOI: 10.1016/j.jcot.2021.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 02/07/2023] Open
Abstract
Surgeries for Rotator Cuff (RC) pathologies are required for either trauma or degenerative related aetiologies. Various surgical techniques from open to arthroscopic repair, are being undertaken by orthopaedic surgeons. Peri-operative anaesthetic management of the patients undergoing rotator cuff repair requires understanding the surgical procedure and patient status for optimal anaesthetic planning. Such management mandates a thorough pre-operative evaluation, including clinical history, examination, and relevant investigations. Patients with acute trauma associated Rotator Cuff (RC) tears should be assessed for visceral injuries using appropriate injury evaluation systems before such repairs. On the other hand, patients with degenerative tears tend to be older with associated comorbidities. Hence pre-operative optimisation is necessary according to risk stratification. Anaesthetic techniques for Rotator Cuff (RC) surgery include general anaesthesia or regional anaesthesia. These are individualised according to patient assessment and surgical procedure planned. Knowledge of relevant surgical anatomy is essential for intra-operative, and post-operative neural blockade techniques since optimal peri-operative analgesia improve overall patient recovery. The occurrence of a peri-operative complication should be recognised as timely management improves the patient-related surgical outcomes. We describe the relevance of surgical anatomy, the effect of patient positioning, irrigating fluids, various anaesthetic techniques and an overview of regional and medical interventions to manage pain in patients undergoing for Rotator Cuff (RC) surgery.
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Affiliation(s)
- Indubala Maurya
- Department of Anaesthesiology, Super Speciality Cancer Institute & Hospital, C.G. City, Sultanpur Road, Lucknow, Uttar Pradesh, India
| | - Rakesh Garg
- Additional Professor of Anaesthesiology, Critical Care and Pain, Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
- Corresponding author. Department of Orthopaedics, Atal Bihari Vajpayee institute of medical sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Karthikeyan P. Iyengar
- Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, 110076, New Delhi, India
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Takahashi R, Kajita Y, Harada Y, Iwahori Y, Deie M. Post-operative pain control following arthroscopic rotator cuff repair: Intravenous acetaminophen versus interscalene brachial plexus block; A prospective randomized study. J Orthop 2021; 25:6-9. [PMID: 33897133 DOI: 10.1016/j.jor.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/23/2021] [Indexed: 11/19/2022] Open
Abstract
Background With the increasing number of patients undergoing arthroscopic rotator cuff repair (ARCR), postoperative pain control in these patients has become an important issue. We investigated and compared post-operative pain relief with intravenous acetaminophen (IA) and interscalene brachial plexus block (IBPB) after ARCR. Methods This prospective study involved 66 consecutive patients who underwent ARCR in 2019-2020 at our hospital. Overall, 23 and 43 shoulders were assigned to the IA and IBPB groups, respectively. We evaluated the visual analog scale (VAS) pain scores at rest, during activity, and at night for the first 72 h postoperatively. We compared the results statistically between the groups. A p-value <0.05 was considered statistically significant. Results VAS scores for night pain in the IBPB group were significantly lower than those in the IA group for the first 24 h postoperatively (p = 0.017). In contrast, the same scores were significantly lower in the IA group than in the IBPB group at 72 h postoperatively (p = 0.024). Other scores were not significantly different between the groups. Conclusions IBPB provides superior night pain control during the first 24 h postoperatively, and IA provides superior night pain control at 72 h postoperatively. However, there were no significant differences in other pain scores between the two groups.
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Affiliation(s)
| | - Yukihiro Kajita
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
| | - Yohei Harada
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
| | - Yusuke Iwahori
- Department of Orthopaedic Surgery, Asahi Hospital, Japan
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
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Kara YS, Hapa O, Işın Y, Kılıç Aİ, Havitçioğlu H. A comparison of ice wrap and subacromial injection for postoperative pain and edema control following arthroscopic rotator cuff repair. J Orthop Traumatol 2020; 21:17. [PMID: 32876791 PMCID: PMC7468014 DOI: 10.1186/s10195-020-00556-6] [Citation(s) in RCA: 4] [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: 12/19/2019] [Accepted: 08/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background Postoperative pain and edema are the most common problems associated with arthroscopic rotator cuff repair. The purpose of the present study was to compare ice wrap and subacromial injection (SI) as treatments for early postop pain and edema control and to contrast them with a control group. Materials and methods 59 patients treated with arthroscopic rotator cuff repair were randomized into three groups: 23 patients who received an ice wrap, 20 patients who received a SI, and a control group of 16 patients. Results Patient demographics, comorbidities, tear retraction, degree of fatty muscle degeneration, surgical procedures, and amount of irrigation fluid were similar for the three groups, which also showed similar results regarding postoperative pain and edema control as well as analgesic consumption. Conclusions The present study failed to show any difference in effectiveness between the two most common pain management modalities, or between those modalities and the control group. Level of evidence IV, prospective observational study.
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Affiliation(s)
- Yavuz Selim Kara
- Department of Orthopedic Surgery, Dokuz Eylül University, Izmir, Turkey
| | - Onur Hapa
- Department of Orthopedic Surgery, Dokuz Eylül University, Izmir, Turkey.
| | - Yağmur Işın
- Department of Orthopedic Surgery, Dokuz Eylül University, Izmir, Turkey
| | - Ali İhsan Kılıç
- Department of Orthopedic Surgery, Dokuz Eylül University, Izmir, Turkey
| | - Hasan Havitçioğlu
- Department of Orthopedic Surgery, Dokuz Eylül University, Izmir, Turkey
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Toyooka S, Miyamoto W, Ito M. Editorial Commentary: Postoperative Pain Management After Arthroscopic Rotator Cuff Repair: The Journey to Pain Relief. Arthroscopy 2020; 36:1251-1252. [PMID: 32370887 DOI: 10.1016/j.arthro.2020.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 02/02/2023]
Abstract
Presently, interscalene block is the undisputed gold-standard procedure for postoperative pain management after arthroscopic rotator cuff surgery in patients experiencing considerable pain. However, the challenge is to make this short-term total pain relief long-term.
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Gross BD, Paganessi SA, Vazquez O. Comparison of Subacromial Injection and Interscalene Block for Immediate Pain Management After Arthroscopic Rotator Cuff Repair. Arthroscopy 2020; 36:1243-1250. [PMID: 32057980 DOI: 10.1016/j.arthro.2020.01.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the efficacy of a subacromial injection (SAI) with a single-shot interscalene block (ISB) for immediate postoperative pain relief after outpatient arthroscopic rotator cuff repair (ARCR). METHODS We performed a retrospective chart review of consecutive patients who underwent ARCR. Patients received either an ISB before the procedure or an SAI after the procedure. Preoperative baseline patient characteristics were collected and compared. Visual analog scale (VAS) pain scores were recorded preoperatively, at 15-minute intervals over a 120-minute period in the postanesthesia care unit (PACU), and at discharge. Differences in VAS scores between groups were compared with known values of the minimal clinically important difference, and the percentage of patients with VAS scores below the patient acceptable symptom state was tabulated. Differences between preoperative characteristics were assessed using the Mann-Whitney U, Fisher exact, or χ2 test. The Mann-Whitney U test was also used to evaluate VAS scores and total time spent in the PACU between groups. RESULTS The median VAS score was significantly lower in the ISB group at PACU admission, at all intervals throughout the PACU stay, and at discharge (P < .0001). The median total time in the PACU was 107 minutes (25th percentile-75th percentile, 90-120 minutes) and 210 minutes (25th percentile-75th percentile, 175-274 minutes) in the ISB and SAI groups, respectively (P < .0001). Between-group differences in VAS scores were greater than the values of the minimal clinically important difference at each measured interval. A total of 98% and 67% of patients in the ISB and SAI groups, respectively, were discharged with VAS scores below the patient acceptable symptom state of 3. CONCLUSIONS Patients receiving an ISB experience significantly less pain than those receiving an SAI. In addition, they are discharged home from the PACU in half the time as patients receiving an SAI. On the basis of the comparative efficacy, an SAI cannot replace an ISB after ARCR. The ISB should therefore remain the standard of care as an adjunct to postoperative analgesia for patients who undergo outpatient ARCR. LEVEL OF EVIDENCE Level III, retrospective, comparative therapeutic trial.
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Affiliation(s)
| | | | - Oscar Vazquez
- Active Orthopedics and Sports Medicine, Hackensack; Hudson Crossing Surgery Center, Fort Lee; Department of Orthopedics, Hackensack University Medical Center, Hackensack, New Jersey, U.S.A
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Li H, Chen Y, Chen S. Postoperative residual pain is associated with a high magnetic resonance imaging (MRI)-based signal intensity of the repaired supraspinatus tendon. Knee Surg Sports Traumatol Arthrosc 2019; 27:4014-4020. [PMID: 31451843 DOI: 10.1007/s00167-019-05651-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/26/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess patients with and without postoperative residual pain and to compare clinical function and magnetic resonance imaging (MRI) appearance of the repaired supraspinatus tendon between patients with and without pain. METHODS One-hundred and seventeen patients with supraspinatus tear were included in this study. Visual Analog Scale (VAS) scores for pain were assessed at a follow-up of at least 1 year. Patients with residual shoulder pain were enrolled in the residual pain group (RP group) and patients without pain enrolled in the no pain group (NP group). The American Shoulder and Elbow Surgeons (ASES) shoulder evaluation form, the modified University of California at Los Angeles (UCLA) score and the Fudan University Shoulder Score (FUSS) were also used to evaluate shoulder function. MRI examinations were performed to evaluate rotator cuff integrity according to the Sugaya method, and muscular hypotrophy, fatty infiltration, and signal/noise quotient (SNQ) of the rotator cuff tendon. RESULTS Thirty-five patients had residual pain (RP group) and 82 patients had no pain (NR group). At the final follow-up, there was a significant difference in ASES (92 ± 8 points vs 76 ± 10 points; p < 0.001), UCLA (32 ± 3 points vs 28 ± 3 points; p < 0.001), FUSS (90 ± 7 points vs 80 ± 9 points; p < 0.001) and strength (9 ± 3 kg vs 6 ± 2 kg; p < 0.001) between the NP group and the RP group, respectively. Postoperative MRI revealed that there was no significant difference in the retear rate (9.8% vs 8.6%; ns), the muscular hypotrophy (ns), and the fatty infiltration index (0.9 ± 0.2 vs 0.9 ± 0.2; ns) between the NP and the RP groups, respectively. The postoperative tendon SNQ of the RP group was significantly higher than that of the NP group (4.6 ± 2.5 vs 3 ± 1.7; p < 0.001). There was a significant association between tendon SNQ and VAS for this cohort ([Formula: see text] = 0.29; p = 0.003). CONCLUSION Postoperative residual pain is associated with a high MRI signal intensity of the repaired supraspinatus tendon. Since high signal intensity of tendon tissue indicates degenerated tendon tissue quality, it highlighted the necessity of debriding the degenerated rotator cuff tendon tissue. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hong Li
- Department of Sports Medicine, Huashan Hospital, No 12, Wulumuqi Zhong Road, Shanghai, 200040, People's Republic of China
| | - Yuzhou Chen
- Department of Sports Medicine, Huashan Hospital, No 12, Wulumuqi Zhong Road, Shanghai, 200040, People's Republic of China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, No 12, Wulumuqi Zhong Road, Shanghai, 200040, People's Republic of China.
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Mai H. Comment on Medina et al.: orthopaedic surgery patients who use recreational marijuana have less pre-operative pain. INTERNATIONAL ORTHOPAEDICS 2019; 43:1541. [PMID: 30834952 DOI: 10.1007/s00264-019-04319-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Harry Mai
- Department of Anesthesiology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA.
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Tsukada S, Kurosaka K, Maeda T, Iida A, Nishino M, Hirasawa N. Early stage periarticular injection during total knee arthroplasty may provide a better postoperative pain relief than late-stage periarticular injection: a randomized-controlled trial. Knee Surg Sports Traumatol Arthrosc 2019; 27:1124-1131. [PMID: 30238239 PMCID: PMC6435609 DOI: 10.1007/s00167-018-5140-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/11/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE This study was performed to determine whether periarticular injection performed in the early stage of total knee arthroplasty (TKA) could provide a better postoperative pain relief than periarticular injection performed in the late stage of TKA. The hypothesis was based on the concept that analgesic intervention before the onset of noxious stimuli would be associated with less postoperative pain. METHODS A total of 105 participants were randomly assigned to receive superficial injection just prior to arthrotomy (early stage periarticular injection group) or superficial injection after implanting the prosthesis (late-stage periarticular injection group) in patients undergoing unilateral TKA with 1:1 treatment allocation. In both groups, deep injection was performed according to the same schedule (just prior to implanting prosthesis). The solution consisted of 300 mg of ropivacaine, 8 mg of morphine, 40 mg of methylprednisolone, 50 mg of ketoprofen, and 0.3 mg of epinephrine mixed with normal saline to a final volume of 60 mL. All surgeries were managed under general anesthesia without any regional blocks. Registry-specified primary outcome was postoperative pain score at rest measured at the recovery room using a 100-mm visual analog scale (VAS). The VAS score was compared between two groups and assessed to reach the reported threshold values for the minimal clinically important difference (MCID) of 10 mm for the postoperative VAS score. RESULTS The VAS score at the recovery room was significantly lower in the early stage periarticular injection group than the late-stage periarticular injection group (23 ± 25 mm versus 39 ± 34 mm, respectively; 95% confidence interval 4-28 mm; p = 0.0078). The mean difference in the primary outcome fulfilled the MCID value. CONCLUSIONS Bringing forward the timing of periarticular injection may provide significant and clinically meaningful improvement in pain following TKA under general anesthesia. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, Mito, Ibaraki, 310-0035, Japan.
| | - Kenji Kurosaka
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, Mito, Ibaraki 310-0035 Japan
| | - Tetsuyuki Maeda
- Department of Anesthesiology, Hokusuikai Kinen Hospital, Mito, Japan
| | - Akihiro Iida
- Department of Anesthesiology, Hokusuikai Kinen Hospital, Mito, Japan
| | - Masahiro Nishino
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, Mito, Ibaraki 310-0035 Japan
| | - Naoyuki Hirasawa
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, Mito, Ibaraki 310-0035 Japan
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