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Uchida R, Hombu A, Ishida Y, Nagasawa M, Chosa E. Investigation of cryotherapy for pain relief after arthroscopic shoulder surgery. J Orthop Surg Res 2022; 17:553. [PMID: 36536379 PMCID: PMC9764510 DOI: 10.1186/s13018-022-03404-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Recently, cryotherapy has become a common practice for postoperative pain management. The current accepted practice in Japan is the use of cryotherapy at 5 °C after arthroscopic shoulder surgery. However, this therapy has been reported to be highly intense because the sustained low temperature causes discomfort for patients. The optimum temperature and duration of cooling required for comfortable and effective cryotherapy after arthroscopic shoulder surgery were investigated. METHODS Because pain levels might differ depending on the condition, we selected 52 patients with rotator cuff injuries, which were the most common disorders indicated for arthroscopic shoulder surgery. Patients were treated with cryotherapy at 5 °C or 10 °C for 16 h or 24 h. The pain level was determined using the visual analogue scale, and deep shoulder joint temperatures were recorded at different time points for analysis. RESULTS Pain after arthroscopic shoulder surgery was found to be related to the presence of a brachial plexus block using the interscalene approach during surgical anesthesia. To obtain effective analgesia with cryotherapy, the cooling temperature and duration of cryotherapy had to be changed based on the presence or absence of the brachial plexus block. Patients who received brachial plexus blocks had the lowest recorded pain scores after receiving cryotherapy at 5 °C for 24 h after surgery. Patients who did not receive the block had the lowest recorded pain scores when receiving cryotherapy at either 5 °C for 16 h or 10 °C for 24 h. CONCLUSIONS Using universal cryotherapy intensity and duration settings regardless of the use of other interventions is likely to unintentionally increase postoperative pain levels. This study revealed that cryotherapy at 5 °C for 24 h was optimal for patients who received an anesthesia block and at 5 °C for 16 h or at 10 °C for 24 h for those who did not receive the anesthesia block. These results can be used as a reference for setting the temperature and duration of cryotherapy after arthroscopic shoulder surgery.
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Affiliation(s)
- Rinko Uchida
- grid.410849.00000 0001 0657 3887School of Nursing, Faculty of Medicine, University of Miyazaki, 5200 Kihara Kiyotake-Cho, Miyazaki-City, Miyazaki 889-1692 Japan
| | - Amy Hombu
- grid.410849.00000 0001 0657 3887Center for Language and Cultural Studies, University of Miyazaki, Miyazaki, Japan
| | | | - Makoto Nagasawa
- grid.410849.00000 0001 0657 3887Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Etsuo Chosa
- grid.410849.00000 0001 0657 3887Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Jump CM, Waghmare A, Mati W, Malik RA, Charalambous CP. The Impact of Suprascapular Nerve Interventions in Patients with Frozen Shoulder: A Systematic Review and Meta-Analysis. JBJS Rev 2021; 9:01874474-202112000-00005. [PMID: 34936584 DOI: 10.2106/jbjs.rvw.21.00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Frozen shoulder is a common condition resulting in severe pain and restricted range of motion. An assessment of the effectiveness of interventions may provide an improved understanding of the development and management of frozen shoulder. METHODS A literature search was conducted using Embase, the Cumulative Index of Nursing and Allied Health (CINAHL), the Cochrane Central Register of Controlled Trials (CENTRAL), and National Center for Biotechnology Information PubMed using relevant terms. Studies were included if they assessed the outcomes of interventions on the suprascapular nerve that aim to improve the symptoms of frozen shoulder. RESULTS A database search returned 196 articles. After review, 9 articles met the inclusion criteria and were included in the analysis. Suprascapular nerve interventions (nerve block, pulsed radiofrequency lesioning) are associated with improvement in pain, motion, and function. Meta-analysis showed that pain (Hedges g, -3.084 [95% confidence interval (CI), -4.273 to -1.894]; p < 0.001) and range of motion (Hedges g, 2.204 [95% CI, 0.992 to 3.415]; p < 0.001) improved significantly following suprascapular nerve block (SSNB). CONCLUSIONS SSNB is associated with significant improvements in shoulder pain and range of motion in patients with frozen shoulder. Further randomized controlled trials comparing SSNB with intra-articular injection and other nonoperative treatments are required to fully define its role in the management of frozen shoulder. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christopher M Jump
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Ashish Waghmare
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Wael Mati
- Department of Radiology, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | | | - Charalambos P Charalambous
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, United Kingdom.,School of Medicine, University of Central Lancashire, Preston, United Kingdom
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Borbas P, Eid K, Ek ET, Feigl G. Innervation of the acromioclavicular joint by the suprascapular nerve. Shoulder Elbow 2020; 12:178-183. [PMID: 32565919 PMCID: PMC7285973 DOI: 10.1177/1758573219851005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/29/2019] [Accepted: 04/24/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND The suprascapular nerve is largely responsible for the majority of the sensory innervation of the acromioclavicular joint. In this anatomical study, we describe, in detail, the anatomy of the sensory innervation of the acromioclavicular joint by the branches of the suprascapular nerve. METHODS Twenty-seven shoulders from 17 cadaveric specimens were carefully dissected to identify the course of the suprascapular nerve, with the main focus being on the sensory innervation of the acromioclavicular joint. Nine specific measurements of the acromioclavicular joint sensory nerves were made of each shoulder in relation to distinct anatomical landmarks to determine the mean location and course of these nerves. RESULTS In all 27 shoulders (100%), a sensory branch to the acromioclavicular joint with a proximal origin from the suprascapular nerve could be depicted ("first sensory branch"). The mean length of this branch was 4.3 cm (range: 3.3-5.3 cm). In 14 shoulders (52%), a further sensory branch of the suprascapular nerve innervating the posterior acromioclavicular joint capsule could be identified ("second sensory branch"). DISCUSSION A detailed anatomical description of the sensory innervation of the acromioclavicular joint from suprascapular nerve branches was performed, which can potentially aid in the development of more focused anesthetic blockades and acromioclavicular joint denervation procedures.
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Affiliation(s)
- Paul Borbas
- Center for Orthopedic Surgery, State Hospitals Aarau and Baden, Baden, Switzerland,Institute of Macroscopical and Clinical Anatomy, Medical University of Graz, Graz, Austria *Current affiliation: Department of Orthopaedics, Cantonal Hospital Baden, Baden, Switzerland,Paul Borbas, Kantonsspital Baden, Im Ergel 1, 5404 Baden, Switzerland.
| | - Karim Eid
- Center for Orthopedic Surgery, State Hospitals Aarau and Baden, Baden, Switzerland,Institute of Macroscopical and Clinical Anatomy, Medical University of Graz, Graz, Austria *Current affiliation: Department of Orthopaedics, Cantonal Hospital Baden, Baden, Switzerland
| | - Eugene T Ek
- Melbourne Orthopaedic Group and Department of Surgery, Monash University, Melbourne, Australia
| | - Georg Feigl
- Institute of Macroscopical and Clinical Anatomy, Medical University of Graz, Graz, Austria *Current affiliation: Department of Orthopaedics, Cantonal Hospital Baden, Baden, Switzerland
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Sethi PM, Sheth CD. Determining anatomic accuracy of shoulder field injection: triangular injection technique does adequately reach pain transmitters. JSES Int 2020; 4:427-430. [PMID: 32939463 PMCID: PMC7479046 DOI: 10.1016/j.jseint.2020.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Controlling pain after shoulder surgery is a critical component of postsurgical care. Several recent studies have described the use of periarticular, local infiltration anesthesia, and field blocks (FBs) with clinical efficacy after shoulder surgery. The anatomic accuracy and safety of these FBs have not been well described. The purpose of this study was to determine the accuracy of a surgeon performed shoulder field injection. We hypothesized that our field injection would adequately reach the pain transmitters responsible for postsurgical shoulder pain. Methods A total of 10 cadaveric specimens were used in the study. A mixture of liposomal bupivacaine, normal saline, and methylene blue totaling 60 cc was prepared. After injection, the specimens were left for 4 hours to allow medication diffusion. The dissection of specimens was performed to identify 4 areas: axillary nerve, suprascapular nerve, supraclavicular nerves, and joint capsule. On dissection, accuracy rates were determined for each area. Results All 10 cadaveric specimens were injected and dissected to completion. The dissection of the axillary nerve showed methylene blue dye surrounding the nerve in 10 of 10 (100%) specimens, the suprascapular nerve in 9 of 10 (90%), and the supraclavicular nerves in 10 of 10 (100%). Zero of 10 (0%) specimens had any dye penetrate into the glenohumeral joint or capsule. Conclusion The accuracy rates of the injection of the mixture into the shoulder specimens suggest potential to reproduce an FB to the tissues that are responsible for postoperative pain after shoulder surgery. This may represent an option when interscalene nerve block is not desired or contraindicated.
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Affiliation(s)
- Paul M Sethi
- ONS Foundation for Clinical Research and Education, Greenwich, CT, USA
| | - Chirag D Sheth
- ONS Foundation for Clinical Research and Education, Greenwich, CT, USA
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Koga R, Funakoshi T, Yamamoto Y, Kusano H. Suprascapular nerve block versus interscalene block for analgesia after arthroscopic rotator cuff repair. J Orthop 2020; 19:28-30. [PMID: 32021031 DOI: 10.1016/j.jor.2019.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/03/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ryuji Koga
- Keiyu Orthopaedic Hospital, Tatebayashi, Japan
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A prospective study of two methods of analgesia in shoulder arthroscopic procedures as day case surgery. J Clin Orthop Trauma 2020; 11:S368-S371. [PMID: 32523295 PMCID: PMC7275286 DOI: 10.1016/j.jcot.2019.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 06/08/2019] [Accepted: 06/08/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND & PURPOSE The recent advances in anaesthesia and analgesia have significantly improved the early recovery and effective post-operative pain control in day care surgery e.g. shoulder arthroscopic procedures. Adequate analgesia improves the early rehabilitation for a better outcome. We prospectively evaluated the post-operative pain relief following the two methods of analgesia i.e. regional Inter-scalene block (ISB) vs Intra-articular (IA) injection using 0.5% Chirocaine in various therapeutic arthroscopic shoulder procedures. METHODS A prospective comparative study was performed on a group of 105 patients (ASA grade I or II) who underwent the following procedures at two different hospitals: diagnostic arthroscopy, subacromial decompression (SAD) alone, SAD in combination with mini open cuff repairs or distal clavicle excision, anterior stabilization (Bankart's repair) and inferior capsular shift. A successful Inter-scalene block (0.5% Chirocaine-30mls) preceded the general anaesthesia (Group 1-52 patients). Local intra-articular infiltration (0.5% Chirocaine - 20 mls) was given postoperatively (Group 2-53 patients). Post operatively visual analogue scores (VAS) from 0 (no pain) to 10 (severe pain) were assessed in post-anaesthesia care unit (PACU), at 4hrs, at 24hrs and at 48 h. The amount of morphine consumption for the first 2 days after surgery was recorded. RESULTS Patient characteristics were similar in both groups at both the hospitals. The median postoperative pain score of VAS <3 was observed in both groups. Significant difference (p < 0.0001) was observed in the VAS scores between the two groups at all the time intervals. The mean length of adequate sensory block in group 1 was significantly higher than in group 2 [20.5 h: 4.2 h] (p < 0.001). The mean analgesic (morphine) consumption was lower in Group 1 as compared to Group 2 [4.6 mg/24 h: 18.8mg/24 h](p < 0.0001). Bone shaving procedures e.g. SAD, SAD + Rotator Cuff repair, SAD + Lateral clavicular excision required significantly higher analgesia in both groups compared to the soft tissue procedures. CONCLUSION Single dose ISB provided longer and effective postoperative analgesia. The bone shaving procedures required more analgesia in IA Group as compared to ISB Group.
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Lee W, Kim SJ, Choi CH, Choi YR, Chun YM. Intra-articular injection of steroids in the early postoperative period does not have an adverse effect on the clinical outcomes and the re-tear rate after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2019; 27:3912-3919. [PMID: 30980117 DOI: 10.1007/s00167-019-05486-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/11/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to compare clinical outcomes and structural integrity following arthroscopic rotator cuff repair, either with intra-articular injection of corticosteroids in the early postoperative period using ultrasound guidance or without it. METHODS This study included 318 patients who underwent arthroscopic repair for either a partial-thickness or small-to-medium-sized full-thickness rotator cuff tear from 2012 to 2015. Patients were divided into two groups based on the administration of an intra-articular corticosteroids injection at 3 months after the surgery: group A (with corticosteroid injection, n = 56) and group B (without corticosteroid injection, n = 262). Functional outcomes were evaluated using the visual analog scale (VAS) pain score, subjective shoulder value (SSV), American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles (UCLA) shoulder score, and active range of motion (ROM). Postoperative magnetic resonance arthrography (MRA) was performed 6 months postoperatively to assess structural integrity. RESULTS At the 2-year follow-up, both groups showed no significant differences in VAS pain score (group A/B, 1.1 ± 0.9/1.1 ± 1.1), functional scores including SSV (88.5 ± 10.8/88.3 ± 10.0), ASES (90.8 ± 6.6/90.4 ± 6.9), and UCLA scores (30.2 ± 5.6/30.7 ± 5.2), and active ROM including forward flexion (151° ± 8°/153° ± 7°), external rotation (54° ± 5°/55° ± 7°), and internal rotation (10 ± 1/10 ± 2). Follow-up MRA imaging collected 6 months after surgery showed no significant difference in the re-tear rate (n.s.) between group A and B (n = 10/56, 17.9% and 45/262, 17.2%, respectively). CONCLUSIONS Intra-articular corticosteroids injection in the early postoperative period after arthroscopic rotator cuff repair provided satisfactory pain relief and ROM improvement without increasing the re-tear rate or deteriorating clinical outcomes at the 2-year follow-up. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Wonyong Lee
- The Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 120-752, Republic of Korea
| | - Sung-Jae Kim
- The Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 120-752, Republic of Korea
| | - Chong-Hyuk Choi
- The Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 120-752, Republic of Korea
| | - Yun-Rak Choi
- The Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 120-752, Republic of Korea
| | - Yong-Min Chun
- The Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 120-752, Republic of Korea.
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Sethi PM, Brameier DT, Mandava NK, Miller SR. Liposomal bupivacaine reduces opiate consumption after rotator cuff repair in a randomized controlled trial. J Shoulder Elbow Surg 2019; 28:819-827. [PMID: 30928396 DOI: 10.1016/j.jse.2019.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/03/2019] [Accepted: 01/06/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthroscopic rotator cuff repair (ARCR) provides excellent clinical outcomes but is often associated with significant postoperative pain. The use of intraoperative anesthesia in conjunction with multimodal pharmacologic strategies is a widely accepted approach for managing surgical pain and reducing opiate use. The purpose of this study was to determine whether using a combined field and suprascapular nerve block with liposomal bupivacaine (LB) in addition to an interscalene block would provide greater pain relief and a reduction in opiate consumption compared with an interscalene block alone. METHODS The study enrolled 50 patients with full-thickness rotator cuff tears undergoing primary ARCR surgery. Patients were randomized to receive intraoperative LB (n = 25) or not (n = 25) and given postoperative "pain journals" to document visual analog scale pain scores and to track their daily opioid consumption during the first 5 postoperative days. RESULTS Patients in the LB group reported statistically and clinically lower pain scores during postoperative days 1 and 2 (P < .0001 and P = .03, respectively). In addition, patients in the LB group consumed significantly fewer narcotics than the control group during the 5-day period, demonstrating a 64% reduction in total narcotic consumption (P = .002). CONCLUSION The findings of this study suggest that the addition of LB to multimodal anesthetic protocols significantly reduces the acute perioperative pain experienced following rotator cuff repair and the number of narcotic pills consumed in the first 5 days after ARCR. Furthermore, the findings provide guidelines for postoperative narcotic prescribing to reduce the quantity of opiates prescribed.
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Affiliation(s)
- Paul M Sethi
- Orthopaedic & Neurosurgery Specialists, Greenwich, CT, USA; The ONS Foundation for Clinical Research and Education, Greenwich, CT, USA.
| | - Devon T Brameier
- The ONS Foundation for Clinical Research and Education, Greenwich, CT, USA
| | - Nikhil K Mandava
- The ONS Foundation for Clinical Research and Education, Greenwich, CT, USA
| | - Seth R Miller
- The ONS Foundation for Clinical Research and Education, Greenwich, CT, USA
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Physiotherapists' use of suprascapular nerve blocks: an online survey. Physiotherapy 2019; 105:461-468. [PMID: 30745062 DOI: 10.1016/j.physio.2019.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 01/04/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is some evidence to support the use of suprascapular nerve blocks (SSNBs) to manage shoulder pain. Although many patients with shoulder pain are referred to physiotherapy, there are no data describing whether physiotherapists currently use SSNBs for these patients. OBJECTIVE To explore if physiotherapists who manage musculoskeletal shoulder pain are using SSNBs and identify, of those who responded to an online questionnaire, how commonplace this practice is in the United Kingdom (UK) DESIGN: An online, cross-sectional, questionnaire survey was developed for physiotherapists involved in the management of patients with shoulder pain. METHODS A snowball sampling method was used to invite physiotherapists to complete the online survey, using email, research advertisements in a professional magazine and via social media. The questionnaire captured respondents' demographic and professional practice characteristics, their knowledge and use of SSNBs and their views and experiences regarding SSNBs as a treatment for shoulder pain. RESULTS In total, there were 529 responders to the survey. Of these, 492 were eligible and formed the sample for analyses. The majority of responders (290/474; 61%) were from the UK. Of these, the majority (259/282; 92%) were familiar with SSNBs as a method of treatment for shoulder pain, although few (9/149; 6%) reported regularly using SSNBs in their clinical practice. Only 8 of 287 responders from the UK (3%) reported delivering SSNBs to patients. CONCLUSIONS This survey provides preliminary evidence that the use and delivery of SSNBs by UK physiotherapists is uncommon. Future research is required to investigate the potential value of physiotherapists using this treatment option for their patients with shoulder pain.
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Pani N, Routray SS, Pani S, Mallik S, Pattnaik S, Pradhan A. Post-operative analgesia for shoulder arthroscopic surgeries: A comparison between inter-scalene block and shoulder block. Indian J Anaesth 2019; 63:382-387. [PMID: 31142882 PMCID: PMC6530293 DOI: 10.4103/ija.ija_65_19] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Shoulder arthroscopic surgeries can produce intense post-operative pain. Inter-scalene block (ISB) provides good analgesia after shoulder surgery, but concerns over its associated risks have prompted the search for alternatives. Shoulder block (SHB), which includes suprascapular block along with axillary nerve (AN) block, was recently proposed as an alternative to ISB, but evidence of its efficacy is conflicting. The aim of our study was to compare SHB with ISB in shoulder surgery for post-operative analgesia. Methods A total of 76 patients scheduled for shoulder arthroscopic surgery were equally divided into 2 groups of 38 patients each: ISB group and SHB group. Both the nerve blocks were achieved by using ultrasound and a nerve stimulator. Visual analogue scale (VAS) scores were evaluated at 1, 4, 6, 12 and 24 h post-operatively. The time to first analgesia request, total analgesic requirement for 24 h post-operatively, patient satisfaction and any complications were recorded. Results SHB provided equivalent analgesia to ISB in terms of post-operative VAS scores. Time to first analgesic request was 6.2 ± 1.3 h in ISB group and 5.9 ± 1.2 h in SHB group, which was not statistically significant. Complications like subjective dyspnoea and weakness of arm were significantly higher in ISB group compared to SHB group. Patient satisfaction scores were also significantly higher in SHB group compared to ISB group. Conclusion SHB is as effective as ISB for post-operative pain relief and with fewer complications due to selective blockade of suprascapular and axillary nerves.
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Affiliation(s)
- Nibedita Pani
- Department of Anaesthesiology and Critical Care, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Sidharth S Routray
- Department of Anaesthesiology and Critical Care, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Soveena Pani
- Department of Anaesthesiology and Critical Care, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Soumyakanta Mallik
- Department of Anaesthesiology and Critical Care, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Santiswaroop Pattnaik
- Department of Anaesthesiology and Critical Care, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Amit Pradhan
- Department of Anaesthesiology and Critical Care, KIMS, Bhubaneswar, Odisha, India
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Marty P, Ferré F, Basset B, Marquis C, Bataille B, Chaubard M, Merouani M, Rontes O, Delbos A. Diaphragmatic paralysis in obese patients in arthroscopic shoulder surgery: consequences and causes. J Anesth 2018; 32:333-340. [PMID: 29511891 DOI: 10.1007/s00540-018-2477-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/28/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Ambulatory process in arthroscopic shoulder surgery has boomed over past decades. Some anesthetic techniques such as interscalene block (ISB) and its surrogates are associated with diaphragmatic paralysis and might compromise outpatient procedure. HYPOTHESIS This study aims to assess consequences of diaphragmatic paralysis in obese patients. METHODS This prospective observational study screened patients with body mass index (BMI) ≥ 30 kg/m2 undergoing acromioplasty or supraspinatus tendon repair. Surgery was performed using brachial plexus block, and the method of brachial plexus block was left at the discretion of attending anesthesiologists. Post-operative hemidiaphragmatic paralysis was evaluated using M-mode ultrasonography and its consequences on patient ventilation were assessed: occurrence of hypoxic episode defined as oxygen saturation less than 90% (by pulse oximeter) in room air, dyspnea and failure of ambulatory procedure. Causes of diaphragmatic paralysis were also analyzed. RESULTS Ninety-one patients were screened, 82 patients were included in this study and 37 patients (45%) presented diaphragmatic paralysis. Compared to patients without diaphragmatic paralysis, diaphragmatic paralysis was associated with dyspnea [10 (27%) versus 1 (2%); p = 0.0019], occurrence of patients presenting at least one hypoxic episode [6 (16%) versus 1 (2%); p = 0.02] and failure of ambulatory process [10 (27%) versus 1 (2%); p = 0.009]. The combination of axillary and suprascapular nerve blocks, but also low volume ISB, was found to be protective against diaphragmatic paralysis when compared to high volume ISB [Odds ratios 0.0019 (0.001-0.026) and 0.0482 (0.008-0.27), respectively; p < 0.001]. CONCLUSION In patients with BMI ≥ 30 kg/m2 undergoing arthroscopic shoulder surgery, diaphragmatic paralysis is associated with dyspnea, occurrence of hypoxic episodes and failure of ambulatory procedure. High volume ISB and also, to a lesser extent, low volume ISB were found to be responsible for diaphragmatic paralysis. TRIAL REGISTRY NUMBER Registration n° 2014-202.
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Affiliation(s)
- Philippe Marty
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France.
| | - Fabrice Ferré
- Département Anesthésie-Réanimation, Hôpital Pierre-Paul Riquet, CHU Purpan, 31059, Toulouse, France
| | - Bertrand Basset
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France
| | - Constance Marquis
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France
| | - Benoit Bataille
- Department of Intensive Care, Centre hospitalier Hôtel-Dieu, Narbonne, France
| | - Martine Chaubard
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France
| | - Mehdi Merouani
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France
| | - Olivier Rontes
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France
| | - Alain Delbos
- Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France
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Manouvakhova OV, Macchi V, Fries FN, Loukas M, De Caro R, Oskouian RJ, Spinner RJ, Tubbs RS. Landmarks for Identifying the Suprascapular Foramen Anteriorly: Application to Anterior Neurotization and Decompressive Procedures. Oper Neurosurg (Hagerstown) 2018; 14:166-170. [PMID: 29351679 DOI: 10.1093/ons/opx096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 03/27/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Additional landmarks for identifying the suprascapular nerve at its entrance into the suprascapular foramen from an anterior approach would be useful to the surgeon. OBJECTIVE To identify landmarks for the identification of this hidden site within an anterior approach. METHODS In 8 adult cadavers (16 sides), lines were used to connect the superior angle of the scapula, the acromion, and the coracoid process tip thus creating an anatomic triangle. The suprascapular nerve's entrance into the suprascapular foramen was documented regarding its position within this anatomical triangle. Depths from the skin surface and specifically from the medial-most point of the clavicular attachment of the trapezius to the suprascapular nerve's entrance into the suprascapular foramen were measured using calipers and a ruler. The clavicle was then fractured and retracted superiorly to verify the position of the nerve's entrance into the suprascapular foramen. RESULTS From the trapezius, the nerve's entrance into the foramen was 3 to 4.2 cm deep (mean, 3.5 cm). The mean distance from the tip of the corocoid process to the suprascapular foramen was 3.8 cm. The angle best used to approach the suprascapular foramen from the surface was 15° to 20°. CONCLUSION Based on our study, an anterior suprascapular approach to the suprascapular nerve as it enters the suprascapular foramen can identify the most medial fibers of the trapezius attachment onto the clavicle and insert a finger at an angle of 15° to 20° laterally and advanced to an average depth of 3.5 cm.
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Affiliation(s)
| | - Veronica Macchi
- Institute of Human Anatomy, Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Fabian N Fries
- Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, Grenada
| | - Raffaele De Caro
- Institute of Human Anatomy, Department of Molecular Medicine, University of Padova, Padua, Italy
| | | | | | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, Grenada.,Seattle Science Foundation, Seattle, Washington
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Kamal K, Dahiya N, Singh R, Saini S, Taxak S, Kapoor S. Comparative study of anatomical landmark-guided versus ultrasound-guided suprascapular nerve block in chronic shoulder pain. Saudi J Anaesth 2018; 12:22-27. [PMID: 29416452 PMCID: PMC5789501 DOI: 10.4103/sja.sja_123_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Suprascapular nerve block (SSNB) is an effective method for the treatment of shoulder disorders. The present study was conducted to evaluate and compare the effectiveness of SSNB under ultrasonographic guidance with anatomical landmark-guided (LMG) technique in the treatment of chronic shoulder pain. Materials and Methods: A total of fifty patients with shoulder pain were enrolled in the present prospective randomized study. Patients in Group I (n = 25) received SSNB using the anatomical LMG as technique described by Dangoisse, in whom a total of 6 ml of drug (5 ml of 0.25% bupivacaine and 40 mg methylprednisolone) was injected. Group II patients (n = 25) were given SSNB using the ultrasound guidance with the same amount of drug. Pain was measured using visual analog scale (VAS), range of motion and Shoulder Pain and Disability Index (SPADI) were recorded. Observations were recorded before the block, immediately after the block, and 1 and 4 weeks after the block. Results: There was no statistically significant difference between the VAS score, range of motion and SPADI before the procedure (P > 0.05) in both the groups. Both the groups showed statistically similar improvement of VAS, range of motion and SPADI at 4-week (P > 0.05) follow-up. In Group I, VAS decreased from baseline value of 6.64 ± 1.50–2.04 ± 0.94 at 4 weeks (P < 0.001). In Group II, the VAS decreased from 6.92 ± 1.00 to 1.84 ± 1.03 at 4 weeks (P < 0.01). Conclusion: In our study, both the techniques have produced comparable relief of pain, improvement in shoulder movement, and decreased SPADI 4 weeks after the block.
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Affiliation(s)
- Kirti Kamal
- Department of Anaesthesia and Critical Care, PGIMS, Rohtak, Haryana, India
| | - Naresh Dahiya
- Department of Anaesthesia and Critical Care, PGIMS, Rohtak, Haryana, India
| | - Roop Singh
- Department of Orthopaedics, PGIMS, Rohtak, Haryana, India
| | - Savita Saini
- Department of Anaesthesia and Critical Care, PGIMS, Rohtak, Haryana, India
| | - Susheela Taxak
- Department of Anaesthesia and Critical Care, PGIMS, Rohtak, Haryana, India
| | - Saloni Kapoor
- Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
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Kostretzis L, Theodoroudis I, Boutsiadis A, Papadakis N, Papadopoulos P. Suprascapular Nerve Pathology: A Review of the Literature. Open Orthop J 2017; 11:140-153. [PMID: 28400882 PMCID: PMC5366386 DOI: 10.2174/1874325001711010140] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 01/02/2023] Open
Abstract
Background: Suprascapular nerve pathology is a rare diagnosis that is increasingly gaining popularity among the conditions that cause shoulder pain and dysfunction. The suprascapular nerve passes through several osseoligamentous structures and can be compressed in several locations. Methods: A thorough literature search was performed using online available databases in order to carefully define the pathophysiology and to guide diagnosis and treatment. Results: Suprascapular neuropathy diagnosis is based on a careful history and a thorough clinical and radiological examination. Although the incidence and prevalence of the condition remain unknown, it is highly diagnosed in specific groups (overhead athletes, patients with a massive rotator cuff tear) probably due to higher interest. The location and the etiology of the compression are those that define the treatment modality. Conclusion: Suprascapular neuropathy diagnosis is based on a careful history and a thorough clinical and radiological examination. The purpose of this article is to describe the anatomy of the suprascapular nerve, to define the pathophysiology of suprascapular neuropathy and to present methodically the current diagnostic and treatment strategies.
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Affiliation(s)
- Lazaros Kostretzis
- Department of Orthopaedics, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Theodoroudis
- Department of Orthopaedics, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Nikolaos Papadakis
- Department of Orthopaedics, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pericles Papadopoulos
- Department of Orthopaedics, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
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Trabelsi W, Ben Gabsia A, Lebbi A, Sammoud W, Labbène I, Ferjani M. Suprascapular block associated with supraclavicular block: An alternative to isolated interscalene block for analgesia in shoulder instability surgery? Orthop Traumatol Surg Res 2017; 103:77-83. [PMID: 27916737 DOI: 10.1016/j.otsr.2016.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 10/12/2016] [Accepted: 10/27/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Interscalene brachial plexus block (ISB) is the gold standard for postoperative pain management in shoulder surgery. However, this technique has side effects and potentially serious complications. The aim of this study was to compare the combinations of ultrasound-guided suprascapular (SSB) associated with supraclavicular nerve block (SCB) and ultrasound-guided ISB for postoperative analgesia after shoulder instability surgery. METHODS Sixty ASA physical status I-II patients scheduled to undergo shoulder instability surgery were included. Two groups: (i) the SSB+SCB group (n=30) in which the patients received a combination of US-guided SSB (15mL of bupivacaine 0.25%) and US-guided SCB (15mL of bupivacaine 0.25%) and (ii) the ISB group (n=30) in which the patients received US-guided ISB with 30mL of bupivacaine 0.25%. General anesthesia was administered to all patients. During the first 24h, the variables assessed were time to administer the anesthesia, duration of the analgesia, onset and duration of motor and sensory blockade, opioid consumption, cardiovascular stability, complications, and patient satisfaction. RESULTS Anesthesia induction took more time for the SSB+SCB group than for the ISB group. However, the onset time of motor and sensory blockade was similar in the two groups. Statistical analysis of the visual analog postoperative pain scoring at H0, H6, H12, and H24 showed nonsignificant differences between the groups. Analgesia, the first request for morphine, and total morphine consumption during the first 24h was similar in both groups. No complication was recorded in the SSB+SCB group. However, phrenic nerve block occurred in all patients in the ISB group. CONCLUSION US-guided SCB combined with US-guided SSB was as effective as ISB for postoperative analgesia after shoulder instability surgery without decreasing potential side effects. TRIAL REGISTRATION NCT identifier: NCT02397330.
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Affiliation(s)
- W Trabelsi
- Service d'anesthésie-réanimation, hôpital militaire de Gabès, 6000 Gabès, Tunisia.
| | - A Ben Gabsia
- Service d'anesthésie-réanimation, hôpital militaire principal d'instruction de Tunis, 1008 Tunis, Tunisia
| | - A Lebbi
- Service d'anesthésie-réanimation, hôpital militaire principal d'instruction de Tunis, 1008 Tunis, Tunisia
| | - W Sammoud
- Service d'anesthésie-réanimation, hôpital militaire principal d'instruction de Tunis, 1008 Tunis, Tunisia
| | - I Labbène
- Service d'anesthésie-réanimation, hôpital militaire principal d'instruction de Tunis, 1008 Tunis, Tunisia
| | - M Ferjani
- Service d'anesthésie-réanimation, hôpital militaire principal d'instruction de Tunis, 1008 Tunis, Tunisia
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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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Casanova M, Choi S, McHardy P. Ultrasound-guided posterior cord and selective suprascapular block for shoulder surgery. Br J Anaesth 2016; 117:835. [DOI: 10.1093/bja/aew373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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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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Zanfaly H, Aly A. Shoulder block versus interscalene block for postoperative pain relief after shoulder arthroscopy. AIN SHAMS JOURNAL OF ANESTHESIOLOGY 2016. [DOI: 10.4103/1687-7934.182272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dorn C, Rumpold-Seitlinger G, Farzi S, Auer J, Bornemann-Cimenti H. The Effect of the Modified Lateral Suprascapular Block on Shoulder Function in Patients With Chronic Shoulder Pain. Anesth Pain Med 2015; 5:e31640. [PMID: 26705528 PMCID: PMC4688809 DOI: 10.5812/aapm.31640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 08/25/2015] [Accepted: 08/26/2015] [Indexed: 11/16/2022] Open
Abstract
Background: Suprascapular nerve block (SSNB) is commonly used in pain therapy for patients with chronic shoulder pain. The effect of SSNB on shoulder function has, however, not been investigated so far. If in shoulder function, i.e. the range of motion is increased after application of the nerve block, it can be expected that subsequent physiotherapy, besides being less painful, is also more effective in terms of restoring shoulder mobility. Objectives: Our aim was to evaluate the effect of SSNB on shoulder function, in patients with chronic shoulder pain. Patients and Methods: Patients were evaluated using the Constant-Murley Score (CMS) and number rating scale values for pain. The SSN was blocked using the Feigl approach, with 5 ml ropivacaine 0.5%. Shoulder function and pain were assessed 60 minutes and 24 hours after the block. Results: Totally, 20 patients completed the study. The CMS and pain scores significantly improved after the block. Conclusions: The use of the modified lateral SSNB of Feigl significantly reduces pain and increases shoulder function, in chronic shoulder pain.
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Affiliation(s)
- Christian Dorn
- Department of Anesthesiology and Intensive Care Medicine, Interdisciplinary Pain Clinic, Medical University of Graz, Graz, Austria
| | - Gudrun Rumpold-Seitlinger
- Department of Anesthesiology and Intensive Care Medicine, Interdisciplinary Pain Clinic, Medical University of Graz, Graz, Austria
| | - Sylvia Farzi
- Department of Anesthesiology and Intensive Care Medicine, Interdisciplinary Pain Clinic, Medical University of Graz, Graz, Austria
| | - Johann Auer
- Institute of Anesthesiology, St. Mary’s Hospital, Vorau, Austria
| | - Helmar Bornemann-Cimenti
- Department of Anesthesiology and Intensive Care Medicine, Interdisciplinary Pain Clinic, Medical University of Graz, Graz, Austria
- Corresponding author: Helmar Bornemann-Cimenti, Department of Anesthesiology and Intensive Care Medicine, Interdisciplinary Pain Clinic, Medical University of Graz, Graz, Austria. Tel: +43-31638581103, Fax: +43-31638514664, E-mail:
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Lee HJ, Kim YS, Park I, Ha DH, Lee JH. Administration of analgesics after rotator cuff repair: a prospective clinical trial comparing glenohumeral, subacromial, and a combination of glenohumeral and subacromial injections. J Shoulder Elbow Surg 2015; 24:663-8. [PMID: 25648969 DOI: 10.1016/j.jse.2014.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 11/25/2014] [Accepted: 12/06/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Local analgesic injections are commonly used for pain relief after shoulder surgery. The aim of this study was to compare the efficacy of local injections administered in the glenohumeral joint, the subacromial space, or both locations after arthroscopic rotator cuff repair. METHODS Between March 2011 and December 2011, 121 consecutive patients who had undergone arthroscopic rotator cuff repair surgery were enrolled in the study and all patients were randomly allocated to 3 groups. In group 1, 40 patients received a postoperative glenohumeral injection of bupivacaine (20 mL) and lidocaine (10 mL). In group 2, 42 patients received the same postoperative injection, but it was administered in the subacromial space. In group 3, 39 patients received the same amount of local anesthesia but with half injected in the glenohumeral joint and half in the subacromial space. The visual analog scale was used to assess pain intensity before surgery and at postoperative hours 1, 2, 6, 12, and 24. Demerol was used as a postinjection rescue analgesic, and the total number of administrations was recorded at each time point. RESULTS There were no significant differences between groups in patient age, sex, or rotator cuff tear size (P > .05). The visual analog scale scores for pain between each group were not significantly different at any time point, including before surgery (P > .05). In addition, the amount of supplementary analgesic administered was not significantly different between the groups (P > .05). CONCLUSION Injection of local analgesics after arthroscopic rotator cuff repair relieves postoperative pain regardless of the injection location.
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Affiliation(s)
- Hyo-Jin Lee
- Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University of School of Medicine, Gunpo, Gyeonggi-do, South Korea
| | - Yang-Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - In Park
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dae-Ho Ha
- Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University of School of Medicine, Gunpo, Gyeonggi-do, South Korea
| | - Jun-Hyung Lee
- Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University of School of Medicine, Gunpo, Gyeonggi-do, South Korea
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Yamakado K. Efficacy of arthroscopically placed pain catheter adjacent to the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block) following arthroscopic rotator-cuff repair. Open Access J Sports Med 2014; 5:129-36. [PMID: 24982592 PMCID: PMC4074897 DOI: 10.2147/oajsm.s63345] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Rotator-cuff surgery is well recognized to be a painful procedure. Objectives The purpose of this study was to examine the effectiveness of an arthroscopically placed perineural catheter at the scapular notch to provide a continuous block of the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block [ca-SSNB]) following arthroscopic rotator-cuff repair (ARCR). Materials and methods This level II, prospective, randomized, controlled trial without postoperative blinding included 40 patients, who had a 48-hour pain pump, with 0.2% ropivacaine infusion and a continuous rate of 3 mL/hour, placed via an arthroscopically placed catheter following ARCR with arthroscopic release of the superior transverse ligament: 21 patients had a ca-SSNB, and 19 patients had a continuous subacromial bursal block (SAB). The visual analog scale (at 6 hours and on the first, second, and third postoperative days) and the total number of additional pain-reduction attempts during the 3 postoperative days were calculated. Results The respective visual analog scale scores (mm) obtained from the ca-SSNB and SAB groups were 62.4 and 67.6 (P=0.73) before surgery, 9.1 and 19.4 (P=0.12) at 6 hours after surgery, 24.4 and 44.6 (P=0.019) on the first postoperative day, 19.4 and 40.4 (P=0.0060) on the second postoperative day, and 18.5 and 27.8 (P=0.21) on the third postoperative day. Total additional pain-reduction attempts recorded for the ca-SSNB and SAB groups during the 3 postoperative days were 0.3 times and 1.2 times (P=0.0020), respectively. Conclusion ca-SSNB was highly effective in controlling postoperative pain after ARCR.
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Affiliation(s)
- Kotaro Yamakado
- Department of Orthopaedics, Fukui General Hospital, Fukui, Japan
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Pitombo PF, Meira Barros R, Matos MA, Pinheiro Módolo NS. Selective suprascapular and axillary nerve block provides adequate analgesia and minimal motor block. Comparison with interscalene block. Rev Bras Anestesiol 2014; 63:45-51. [PMID: 23438800 DOI: 10.1016/s0034-7094(13)70197-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 04/11/2012] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Shoulder arthroscopic surgeries evolve with intense postoperative pain. Several analgesic techniques have been advocated. The aim of this study was to compare suprascapular and axillary nerve blocks in shoulder arthroscopy using the interscalene approach to brachial plexus blockade. METHODS According to the technique used, sixty-eight patients were allocated into two groups: interscalene group (IG, n=34) and selective group (SG, n=34), with neurostimulation approach used for both techniques. After appropriate motor response, IG received 30 mL of 0.33% levobupivacaine in 50% enantiomeric excess with adrenalin 1:200,000. After motor response of suprascapular and axillary nerves, SG received 15 mL of the same substance on each nerve. General anesthesia was then administered. Variables assessed were time to perform the blocks, analgesia, opioid consumption, motor block, cardiovascular stability, patient satisfaction and acceptability. RESULTS Time for interscalene blockade was significantly shorter than for selective blockade. Analgesia was significantly higher in the immediate postoperative period in IG and in the late postoperative period in SG. Morphine consumption was significantly higher in the first hour in SG. Motor block was significantly lower in SG. There was no difference between groups regarding cardiocirculatory stability and patient satisfaction and acceptability. Failure occurred in IG (1) and SG (2). CONCLUSIONS Both techniques are safe, effective, and with the same degree of satisfaction and acceptability. The selective blockade of both nerves showed satisfactory analgesia, with the advantage of providing motor block restricted to the shoulder.
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Affiliation(s)
- Patrícia Falcão Pitombo
- Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, SP, Brazil.
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Veado MADC, Teixeira BDS, Castro NCD, Costa LA. É vantajosa a adição de epinefrina na solução de infusão artroscópica no tratamento da lesão do manguito rotador? Rev Bras Ortop 2013. [DOI: 10.1016/j.rbo.2012.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Veado MADC, Teixeira BDS, Castro NCD, Costa LA. Is it advantageous to add epinephrine to the arthroscopic infusion solution for the treatment of rotator cuff injury? Rev Bras Ortop 2013; 48:268-271. [PMID: 31214544 PMCID: PMC6565919 DOI: 10.1016/j.rboe.2012.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 07/23/2012] [Indexed: 11/18/2022] Open
Abstract
Objective: To evaluate the use of epinephrine in arthroscopic infusion serum as a measure to improve the quality of surgical viewing during procedures for treating rotator cuff tears. Methods: This was a prospective randomized double-blind comparative study in which 49 arthroscopic repair procedures on rotator cuff tears were evaluated. Patients presenting ASA I and II surgical risk were included. The patients were placed into two groups: the first with epinephrine (1 mg/L) in the infusion serum and the second with pure physiological solution. A single surgeon was responsible for the procedures, without knowledge of the medication usage. The surgeon rated his quality of viewing during the operation, on an increasing scale from 0 to 10. Interscalene block or suprascapular nerve block was chosen randomly and used in association with general anesthesia. The anesthetist issued final report relating to possible intercurrences. Results: The group with epinephrine received an average score of 9.29 and the group without epinephrine received an average score of 7.16. The difference was statistically significant (p < 0.05). There was no important clinical alteration relating to use of this drug. Conclusion: As well as being safe, addition of epinephrine at a concentration of 1 mg/L to the infusion serum was shown to be effective for improving the visual field during arthroscopy to repair rotator cuff injuries.
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Affiliation(s)
- Marco Antônio de Castro Veado
- Assistant Professor of Faculdade de Ciências Médicas de Minas Gerais; Surgeon from the Shoulder and Elbow Group of Hospital MaterDei, Belo Horizonte, MG, Brazil
| | - Bruno de Souza Teixeira
- Physician; Orthopedist; Shoulder and Elbow Surgeon at Hospital Semper and Hospital Evangélico de Belo Horizonte, Belo Horizonte, MG, Brazil
| | - Nathalia Coelho de Castro
- Sixth-year Medical Students at Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Luciano Assis Costa
- Sixth-year Medical Students at Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil
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Ko SH, Kang BS, Hwang CH. Ultrasonography- or electrophysiology-guided suprascapular nerve block in arthroscopic acromioplasty: a prospective, double-blind, parallel-group, randomized controlled study of efficacy. Arthroscopy 2013; 29:794-801. [PMID: 23419356 DOI: 10.1016/j.arthro.2013.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 12/31/2012] [Accepted: 01/09/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the efficacy of ultrasonography-guided (UG) and electrophysiology-guided (EG) suprascapular nerve block (SNB) for arthroscopic acromioplasty with regard to pain relief. METHODS A prospective, double-blind, randomized controlled clinical trial was performed from June 2007 to April 2010. Patients who were scheduled for elective arthroscopic acromioplasty and who met the inclusion criteria were assigned to 1 of 2 experimental groups (UG or EG SNB) or to 1 blind group (using anatomic landmarks). Before surgery, an SNB was performed with either ultrasonographic or electrophysiologic guidance or with no assistive devices (blind). Variables were collected at 4, 24, 48, and 72 hours postoperatively. RESULTS Sixty-three patients were initially enrolled in the study, but 11 dropped out for various reasons. In the UG group at 4 hours, the visual analog scale score at rest (30 ± 12.0 v 39 ± 9.9 for EG group and 41 ± 11.8 for blind group) and when the patient was moving (42 ± 15.2 v 52 ± 11.5 for EG group and 53 ± 12.6 for blind group) was significantly decreased compared with the EG and blind groups (P < .05). Opioid consumption during the first 24 hours was significantly reduced in the UG and EG groups (4.3 ± 1.9 mg and 3.8 ± 2.3 mg, respectively) compared with the blind group (5.1 ± 2.2 mg) (P < .05). The visual analog scale score at rest and when the patient was moving; the pain score on the University of California, Los Angeles questionnaire; and the activities of daily living score on the American Shoulder and Elbow Surgeons questionnaire in the EG and UG groups improved more than the values in the blind group over the follow-up intervals (P < .05). Morphine consumption in the EG and UG groups by the first, second, and third days was significantly smaller than that in the blind control group (P < .05). CONCLUSIONS UG and EG SNB can reduce pain and painkiller consumption for up to 72 hours postoperatively. Ultrasonographic or electrophysiologic guidance is more effective than the blind method of SNB. LEVEL OF EVIDENCE Level I, randomized controlled trial with significant difference.
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Affiliation(s)
- Sang Hun Ko
- Department of Orthopaedic Surgery, University of Ulsan College of Medicine, Ulsan, Republic of Korea
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Pitombo PF, Barros RM, Matos MA, Módolo NSP. Selective Suprascapular and Axillary Nerve Block Provides Adequate Analgesia and Minimal Motor Block. Comparison with Interscalene Block. Braz J Anesthesiol 2013. [DOI: 10.1016/j.bjane.2012.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Borgeat A, Ekatodramis G, Guzzella S, Ruland P, Votta-Velis G, Aguirre J. Deltoid, triceps, or both responses improve the success rate of the interscalene catheter surgical block compared with the biceps response. Br J Anaesth 2012; 109:975-80. [DOI: 10.1093/bja/aes296] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Analgesic effectiveness of nerve block in shoulder arthroscopy: comparison between interscalene, suprascapular and axillary nerve blocks. Knee Surg Sports Traumatol Arthrosc 2012; 20:2573-8. [PMID: 22434159 DOI: 10.1007/s00167-012-1950-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Postoperative pain in arthroscopic shoulder surgery cannot be easily controlled with analgesics and nerve blocks. This study shows the analgesic effect of interscalene block (ISB) and suprascapular nerve block and axillary nerve block (SSNB + ANB) in patients under patient controlled analgesia (PCA). METHODS Sixty-one patients (26 men and 35 women) who underwent arthroscopic rotator cuff repair were selected and allocated non-randomly to one of three groups: PCA only-group, PCA with ISB-group and PCA with SSNB + ANB-group. Visual analogue scale (VAS) score, degree of satisfaction, PCA usage and incidence of nausea and vomiting were evaluated at the recovery room, 8, 16 and 24 postoperative hours. RESULTS The VAS score of the PCA only-group was highest at the recovery room. The VAS score of the PCA with ISB-group was the lowest, however, with large fluctuations over time. Although the VAS score of the PCA with SSNB + ANB-group was higher than that of the PCA with ISB-group, it was steadily lower than the PCA-only group, without any fluctuations. The degree of satisfaction of the PCA with ISB-group was highest at the recovery room. The number of times the PCA was used at the 8-h postoperative evaluation was largest in the PCA only-group. CONCLUSIONS The initial 24 h after surgery plays a key role in controlling pain after arthroscopic shoulder surgery. PCA with SSNB + ANB is a better anaesthetic choice than PCA with ISB or PCA only during the initial 24 h of the postoperative period. LEVEL OF EVIDENCE Clinical study, Level II.
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Moen TC, Babatunde OM, Hsu SH, Ahmad CS, Levine WN. Suprascapular neuropathy: what does the literature show? J Shoulder Elbow Surg 2012; 21:835-46. [PMID: 22445163 DOI: 10.1016/j.jse.2011.11.033] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 11/23/2011] [Accepted: 11/28/2011] [Indexed: 02/01/2023]
Abstract
Suprascapular neuropathy remains a rare, albeit increasingly recognized, diagnosis. Despite its relatively low prevalence, it must be kept in the shoulder surgeon's mind as a potential cause of shoulder pain, particularly in patients where the history, physical examination, and imaging studies do not adequately explain a patient's symptoms or disability. Although challenging to identify, suprascapular neuropathy can be successfully treated. The current literature shows that the location and mechanism of nerve injury are the most important factors guiding management. Different treatment strategies are required, depending on the specific location and type of nerve injury. Controversy regarding if and when to perform an isolated suprascapular nerve release continues. Furthermore, no recommendations regarding suprascapular nerve release in conjunction with rotator cuff repair can be made at this time, and further research is necessary to better delineate the indications in the future.
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Affiliation(s)
- Todd C Moen
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, NY, USA
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Siegenthaler A. Ultrasound guided interventional pain treatment. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2012. [DOI: 10.1016/j.tacc.2012.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Suprascapular Nerve Block: Important Procedure in Clinical Practice. Braz J Anesthesiol 2012; 62:96-104. [DOI: 10.1016/s0034-7094(12)70108-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 05/19/2011] [Indexed: 11/23/2022] Open
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A randomized study of the effectiveness of suprascapular nerve block in patient satisfaction and outcome after arthroscopic subacromial decompression. Arthroscopy 2011; 27:1323-8. [PMID: 21868190 DOI: 10.1016/j.arthro.2011.05.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 05/23/2011] [Accepted: 05/31/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the efficiency of the suprascapular nerve (SSN) block in pain reduction after arthroscopic subacromial decompression operations and its influence on patient satisfaction. Furthermore, we wanted to evaluate whether better perioperative pain management could positively influence postoperative shoulder function. METHODS In this prospective, randomized, double-blinded clinical trial, 3 groups of patients--each with 15 participants--were treated with SSN block (10 mL of 1% ropivacaine), placebo, or a subacromial infiltration of local anesthesia (20 mL of 1% ropivacaine). Preoperative and postoperative pain was evaluated with a visual analog scale. Functional outcome was measured by the Constant-Murley score, and patient satisfaction was measured anecdotally by interview 2 days, 2 weeks, and 6 weeks after surgery. RESULTS The SSN group reported significantly lower levels of postoperative pain, required significantly less analgesia, had better range of motion, and had higher levels of postoperative satisfaction in comparison to the subacromial infiltration group and placebo group. CONCLUSIONS Patients treated with SSN blocks had less pain overall, which led to a decreased need for analgesics in comparison to the subacromial infiltration and placebo groups. Furthermore, patients in the SSN-blocked group achieved better postoperative ROM and were significantly more satisfied after surgery.
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Nam YS, Jeong JJ, Han SH, Park SE, Lee SM, Kwon MJ, Ji JH, Kim KS. An anatomic and clinical study of the suprascapular and axillary nerve blocks for shoulder arthroscopy. J Shoulder Elbow Surg 2011; 20:1061-8. [PMID: 21839653 DOI: 10.1016/j.jse.2011.04.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 04/12/2011] [Accepted: 04/22/2011] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The combination of suprascapular nerve block (SSNB) and axillary nerve block (ANB) has been reported to provide safe and effective analgesia for arthroscopic shoulder surgery. This study was designed to identify anatomic landmarks of the suprascapular nerve (SSN) and axillary nerve (AN) and to evaluate the effects of SSNB and ANB using the identified landmarks. MATERIALS AND METHODS This study included 52 cadaveric shoulders and 30 patients in the anatomic and clinical studies, respectively. After the exact location of the SSN and AN was identified from the cadavers, the clinical study at the end of the operation and at 8, 16, 24, 32, 40, and 48 hours postoperatively was performed in 2 groups: without both SSNB and ANB (group I) and with both SSNB and ANB (group II). RESULTS The SSN was located at a length of one-half (2/5-3/5, 88%) from the anterior tip of the acromion to the superior angle of the scapula and at a length of two-fifths (1/3-1/2, 100%) from the anterior tip of the acromion to the medial border of the spine. The AN was located at a length of three-fifths (2/5-4/5, 98%) from the acromial angle to the inferior insertion of the teres major muscle. The depth from the skin was 3.20 ± 0.58 cm for the SSN and 2.07 ± 0.45 cm for the AN. The clinical study showed that the total amount of analgesic for patient-controlled anesthesia was markedly decreased at the end of the operation and at 8 hours postoperatively in group II compared with group I. CONCLUSIONS The SSNB and ANB were considered to provide safe and effective analgesia in terms of early postoperative pain in arthroscopic shoulder surgery.
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Affiliation(s)
- Yong-Seok Nam
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Ebraheim NA, Whitehead JL, Alla SR, Moral MZ, Castillo S, McCollough AL, Yeasting RA, Liu J. The suprascapular nerve and its articular branch to the acromioclavicular joint: an anatomic study. J Shoulder Elbow Surg 2011; 20:e13-7. [PMID: 21194975 DOI: 10.1016/j.jse.2010.09.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 09/02/2010] [Accepted: 09/03/2010] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The suprascapular nerve and its articular branch innervate the acromioclavicular (AC) joint. Documenting the detailed anatomy of this innervation in the AC joint, including the pertinent surgical and anatomic relationships of the suprascapular nerve and its branches to the AC joint, will aid in the prevention of injury and the reduction of risk of denervation during shoulder surgery. MATERIALS AND METHODS Twelve shoulders from 6 embalmed human cadavers were bilaterally dissected to study the course of the suprascapular nerve and its motor and sensory branches. RESULTS The sensory branch runs superiorly to the supraspinatus muscle towards the AC joint. The average distance from the supraglenoid tubercle to the nerve at the coracoid base was 15 mm. The average distance from the coracoclavicular ligaments to the nerve at the coracoid base was 6 mm. The average distance from the spinoglenoid notch to the sensory branch at the suprascapular notch was 22 mm. The average length of the sensory branch was 30 mm. In half of the specimen shoulders, the suprascapular artery accompanied the nerve at the suprascapular notch under the transverse scapular ligament. DISCUSSION The innervation of the AC joint by the suprascapular nerve has been described, along with pertinent distances to anatomic landmarks. The sensory branch of the suprascapular nerve, which passed through the scapular notch inferior to the transverse scapular ligament, was found in 100% of the study specimens. CONCLUSION The sensory branch of the suprascapular nerve runs superiorly to the supraspinatus muscle towards the AC joint. The detailed information can be used to help decrease the risk of nerve injury during shoulder surgery and to aid in effectively diagnosing and treating AC joint-related disorders.
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Affiliation(s)
- Nabil A Ebraheim
- Department of Orthopaedic Surgery, University of Toledo Health Science Campus, Toledo, OH, USA
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Ikemoto RY, Murachovsky J, Prata Nascimento LG, Bueno RS, Oliveira Almeida LH, Strose E, de Mello SC, Saletti D. PROSPECTIVE RANDOMIZED STUDY COMPARING TWO ANESTHETIC METHODS FOR SHOULDER SURGERY. Rev Bras Ortop 2010; 45:395-9. [PMID: 27022569 PMCID: PMC4799073 DOI: 10.1016/s2255-4971(15)30386-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of suprascapular nerve block in combination with infusion of anesthetic into the subacromial space, compared with interscalene block. METHODS Forty-five patients with small or medium-sized isolated supraspinatus tendon lesions who underwent arthroscopic repair were prospectively and comparatively evaluated through random assignation to three groups of 15, each with a different combination of anesthetic methods. The efficacy of postoperative analgesia was measured using the visual analogue scale for pain and the analgesic, anti-inflammatory and opioid drug consumption. Inhalation anesthetic consumption during surgery was also compared between the groups. RESULTS The statistical analysis did not find any statistically significant differences among the groups regarding anesthetic consumption during surgery or postoperative analgesic efficacy during the first 48 hours. CONCLUSION Suprascapular nerve block with infusion of anesthetic into the subacromial space is an excellent alternative to interscalene block, particularly in hospitals in which an electrical nerve stimulating device is unavailable.
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Affiliation(s)
- Roberto Yukio Ikemoto
- MSc in Medicine and Head of the Shoulder and Elbow Surgery Group, ABC School of Medicine (FMABC)
| | - Joel Murachovsky
- PhD in Medicine and Attending Physician in the Shoulder and Elbow Surgery Group, ABC School of Medicine (FMABC)
| | | | - Rogerio Serpone Bueno
- Postgraduate Student in Health Sciences and Attending Physician in the Shoulder and Elbow Surgery Group, ABC School of Medicine (FMABC)
| | - Luiz Henrique Oliveira Almeida
- Postgraduate Student in Health Sciences and Attending Physician in the Shoulder and Elbow Surgery Group, ABC School of Medicine (FMABC)
| | - Eric Strose
- MSc in Medicine and Attending Physician in the Shoulder and Elbow Surgery Group, ABC School of Medicine (FMABC)
| | | | - Deise Saletti
- Anesthesiologist in Mario Covas State Hospital, FMABC
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Checcucci G, Allegra A, Bigazzi P, Gianesello L, Ceruso M, Gritti G. A new technique for regional anesthesia for arthroscopic shoulder surgery based on a suprascapular nerve block and an axillary nerve block: an evaluation of the first results. Arthroscopy 2008; 24:689-96. [PMID: 18514113 DOI: 10.1016/j.arthro.2008.01.019] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Revised: 01/09/2008] [Accepted: 01/09/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE We propose a new technique of regional anesthesia that combines suprascapular nerve block (SSNB) and axillary nerve block (ANB) in arthroscopic shoulder surgery. METHODS Twenty consecutive patients undergoing arthroscopic procedures for shoulder cuff diseases were included in the trial. SSNB was performed by introducing the stimulating needle approximately 2 cm medial to the medial border of the acromion and about 2 cm cranial to the superior margin of the scapular spine until supraspinatus or infraspinatus muscle contractions were elicited. Following negative aspiration, 15 mL of a mixture of 2% lidocaine (5 mL) and 0.5% levobupivacaine (10 mL) was injected. ANB was performed; a line was drawn between the lateral-posterior angle of the acromion and the olecranon tip of the elbow. The location was about 2 cm cranial to the convergence of this line with the perpendicular line from the axillary fold. The needle was introduced approximately 2 cm cranial to this crossing point to elicit deltoid muscle contractions, and another 15 mL of the same anesthetic mixture was injected. Five mL of the same mixture was injected into each portal of the arthroscopic area. During surgery, patients were sedated with the use of midazolam. General anesthesia was not performed. Acceptance of the technique was assessed through a postsurgical survey of those treated. RESULTS No serious complications occurred. None of the patients required opiates, analgesics, or general anesthesia during the surgical procedure. Postoperative pain control, which was assessed using a visual analog scale, was effective during the observation time. The total demand for nonopiate analgesics during the first 24 postoperative hours was negligible. Patient satisfaction and comfort were satisfactory. CONCLUSIONS Combining SSNB and ANB is an effective and safe technique for intraoperative anesthesia and postoperative analgesia for certain procedures of shoulder arthroscopic surgery.
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Affiliation(s)
- Giuseppe Checcucci
- Hand Surgery and Microsurgery Unit, University-Hospital Careggi, Florence, Italy.
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Barber FA. Percutaneous arthroscopic release of the suprascapular nerve. Arthroscopy 2008; 24:236.e1-4. [PMID: 18237710 DOI: 10.1016/j.arthro.2007.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Revised: 05/04/2007] [Accepted: 05/08/2007] [Indexed: 02/02/2023]
Abstract
Suprascapular nerve release is often performed for entrapment syndromes and to release pressure on the nerve associated with arthroscopic rotator cuff repair. Previous descriptions use basket forceps or scissors through a separate portal. This report describes an arthroscopic technique inserting a 14-gauge needle percutaneously in the superior suprascapular area while viewing through a standard posterior portal. A shaver through the lateral portal clears the acromion and distal clavicle of soft tissue and exposes the coracoclavicular ligaments. The medial border of the coracoclavicular ligaments (conoid ligament) is identified and then followed inferiorly to its coracoid attachment. The shaver removes the adipose tissue for better visualization and depresses and retracts the supraspinatus muscle. The transverse scapular ligament is located with the suprascapular artery coursing across its superior surface. A 14-gauge beveled needle is inserted in the "soft spot" medial to the junction of the scapular spine and clavicle. This insertion site is located approximately 7 cm medial to the lateral border of the acromion. The transverse scapular ligament is horizontal at this location and can be divided with the needle tip via an anterior-posterior sweeping motion, avoiding the suprascapular artery and decompressing the suprascapular nerve.
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Affiliation(s)
- F Alan Barber
- Plano Orthopedic and Sports Medicine Center, Plano, Texas 75093, USA
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40
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Price D. The Shoulder Block: A New Alternative to Interscalene Brachial Plexus Blockade for the Control of Postoperative Shoulder Pain. Anaesth Intensive Care 2007; 35:575-81. [DOI: 10.1177/0310057x0703500418] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This report describes the development of the shoulder block, an alternative to interscalene brachial plexus blockade for the control of postoperative pain following shoulder surgery. Included is a review of the relevant anatomy of the shoulder joint and its associated structures. Two nerves provide the bulk of the innervation to this area: the suprascapular nerve and the axillary (circumflex) nerve. The shoulder block technique involves selective blockade of both of these nerves instead of general blockade of the entire brachial plexus via the interscalene route. The technique of Meier is used to block the suprascapular nerve in the supraspinous fossa. No descriptions of axillary nerve block were available in the literature, so a technique for blocking this nerve as it travels across the posterior surface of the humerus was developed and is described, along with a discussion of the author's initial clinical experience.
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Affiliation(s)
- D.J. Price
- Department of Anaesthesiology and Perioperative Medicine, North Shore Hospital, Takapuna, Auckland, New Zealand
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