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Kilbasanli S, Kaçmaz M. General anesthesia versus combined interscalene nerve/superficial cervical plexus block in arthroscopic rotator cuff repair: A randomized prospective control trial. Medicine (Baltimore) 2023; 102:e35522. [PMID: 37861492 PMCID: PMC10589582 DOI: 10.1097/md.0000000000035522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND In this study, interscalene brachial plexus block (ISB) with superficial cervical plexus block added and general anesthesia (GA) application were evaluated in terms of intraoperative hemodynamics, operative time and postoperative analgesia need in patients who underwent rotator cuff tear repair. METHODS 70 patients aged between 18 and 75 years were included in this prospective study. Arthroscopic rotator cuff tear repair surgery was performed in all patients. The patients were randomized into 2 groups, namely Group ISB who received a combination of superficial cervical plexus block added to the Interscalene Nerve Block, and Group GA, for those who received GA. Duration of operation, waiting times, intraoperative hemodynamic data, postoperative visual analog scale (VAS), analgesic requirement, as well as patient and surgeon satisfaction levels, were compared between the 2 groups. RESULTS While VAS values at the post-anesthesia care unit were lower in ISB group at 2 and 24 hours (P < .05), there was no significant difference between VAS values measured at 6th and 12th hours (P ≥ .05). In the GA group, postoperative morphine and diclofenac consumption was higher, and rescue analgesia was needed earlier (P < .05). The hospital stay was shorter (P < .05), and surgeon and patient satisfaction were higher in the ISB group (P < .05). CONCLUSION SUBSECTIONS In rotator cuff tear repair anesthesia, ISB with superficial cervical plexus block provides adequate intraoperative anesthesia, low postoperative VAS level, reduced and deferred consumption of opioids and nonsteroidal anti-inflammatory drugs, higher patient and surgeon satisfaction and early discharge.
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Affiliation(s)
- Seval Kilbasanli
- Department of Anesthesiology, Training and Research Hospital, Nigde, Turkey
| | - Mustafa Kaçmaz
- Department of Anesthesiology, Ömer Halisdemir University Faculty of Medicine, Nigde, Turkey
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Sabesan V, Lapica H, Fernandez C, Fomunung C. Evolution of Perioperative Pain Management in Shoulder Arthroplasty. Orthop Clin North Am 2023; 54:435-451. [PMID: 37718083 DOI: 10.1016/j.ocl.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Historically, opioids have been used as a primary conservative treatment for pain related to glenohumeral osteoarthritis (GHOA). However, this practice is concerning as it often leads to overuse, which has contributed to the current epidemic of addiction and overdoses in the United States. Studies have shown that preoperative opioid use is associated with higher complication rates and worse outcomes following surgery, particularly for shoulder arthroplasty. To address these concerns, perioperative pain management for shoulder arthroplasty has evolved over the years to the use of multimodal analgesia.
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Affiliation(s)
- Vani Sabesan
- Department of Orthopedics, JFK/University of Miami, Palm Beach, FL, USA.
| | - Hans Lapica
- Department of Orthopedics, JFK/University of Miami, Palm Beach, FL, USA
| | - Carlos Fernandez
- Department of Orthopedics, JFK/University of Miami, Palm Beach, FL, USA
| | - Clyde Fomunung
- Department of Orthopedics, JFK/University of Miami, Palm Beach, FL, USA
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Kamel EZ, Fathy GM, Talaat M, Bakri MH, Soliman OM, Abd El-Salam MAER, Ismail EA. Ultrasound guided suprascapular and costoclavicular nerve block versus interscalene nerve block for postoperative analgesia in arthroscopic shoulder surgery: A randomized non-inferiority clinical trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2108050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Affiliation(s)
- Emad Zarief Kamel
- Anesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Golnar M Fathy
- Anesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Talaat
- Anesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed H. Bakri
- Anesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Omar M. Soliman
- Anesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Eman A. Ismail
- Anesthesia, Intensive Care, and Pain Management Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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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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Takayama K, Shiode H, Ito H. Ultrasound-guided interscalene block anesthesia performed by an orthopedic surgeon: a study of 1322 cases of shoulder surgery. JSES Int 2021; 6:149-154. [PMID: 35141690 PMCID: PMC8811386 DOI: 10.1016/j.jseint.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Interscalene blocks are becoming increasingly common for shoulder surgeries. This study primarily aimed to demonstrate the efficacy and complications and the secondarily to investigate the anesthesia-related time and patient satisfaction of an ultrasound-guided interscalene block performed by an orthopedic surgeon. Methods We retrospectively reviewed the medical records of 1322 consecutive patients (arthroscopic, 1225 cases; open, 97 cases) with a mean age of 64.2 years, who underwent shoulder surgery (arthroscopic or opensurgery) under an ultrasound-guided interscalene block performed by an orthopedic surgeon at a single institution between December 2012 and December 2019. We investigated patient satisfaction, block success rates, and complications and also compared the anesthesia-related time of an interscalene block with that of general anesthesia (428 cases, arthroscopic, 257 cases; open, 171 cases) for shoulder surgery with patients in the beach chair position during the same period. Difference between total anesthesia time and surgical time was defined as anesthesia-related time. Results Approximately 98.3% of patients were satisfied with an interscalene block, and the block success rate on the first attempt was 99.9%. Total complication incidence was 2.3%, with no recorded life-threatening complications. Anesthesia-related times were significantly shorter in the interscalene block group than those in the general anesthesia group (45 ± 14 min vs. 100 ± 26 min, P < .001). Conclusion An ultrasound-guided interscalene block performed by an orthopedic surgeon for shoulder surgery is effective and safe, requires less time, and has a high patient acceptance rate, making it a feasible and alternative to the block performed by anesthesiologists.
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Affiliation(s)
- Kazumasa Takayama
- Corresponding author: Kazumasa Takayama, MD, 1-1-1 Miwa, Kurashiki, Okayama, 7108602 Japan.
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Sun C, Ji X, Zhang X, Ma Q, Yu P, Cai X, Yang H. Suprascapular nerve block is a clinically attractive alternative to interscalene nerve block during arthroscopic shoulder surgery: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2021; 16:376. [PMID: 34116689 PMCID: PMC8194158 DOI: 10.1186/s13018-021-02515-1] [Citation(s) in RCA: 6] [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: 04/02/2021] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The interscalene brachial plexus block (ISB) is a commonly used nerve block technique for postoperative analgesia in patients undergoing shoulder arthroscopy surgery; however, it is associated with potentially serious complications. The use of suprascapular nerve block (SSNB) has been described as an alternative strategy with fewer reported side effects for shoulder arthroscopy. This review aimed to compare the impact of SSNB and ISB during shoulder arthroscopy surgery. METHODS A meta-analysis was conducted to identify relevant randomized controlled trials involving SSNB and ISB during shoulder arthroscopy surgery. Web of Science, PubMed, Embase, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CNKI, and Wanfang database were searched from 2010 through March 2021. RESULTS We identified 1255 patients assessed in 17 randomized controlled trials. Compared with the ISB group, the SSNB group had higher VAS at rest in PACU (P = 0.003), 1 h after operation (P = 0.005), similar pain score 2 h (P = 0.39), 3-4 h (P = 0.32), 6-8 h after operation (P = 0.05), then lower VAS 12 h after operation (P = 0.00006), and again similar VAS 1 day (P = 0.62) and 2 days after operation (P = 0.70). As for the VAS with movement, the SSNB group had higher pain score in PACU (P = 0.03), similar VAS 4-6 h after operation (P = 0.25), then lower pain score 8-12 h after operation (P = 0.01) and again similar VAS 1 day after operation (P = 0.3) compared with the ISB group. No significant difference was found for oral morphine equivalents use at 24 h (P = 0.35), duration of PACU stay (P = 0.65), the rate of patient satisfaction (P = 0.14) as well as the rate of vomiting (P = 0.56), and local tenderness (P = 0.87). However, the SSNB group had lower rate of block-related complications such as Horner syndrome (P < 0.0001), numb (P = 0.002), dyspnea (P = 0.04), and hoarseness (P = 0.04). CONCLUSION Our high-level evidence established SSNB as an effective and safe analgesic technique and a clinically attractive alternative to interscalene block with the SSNB'S advantage of similar pain control, morphine use, and less nerve block-related complications during arthroscopic shoulder surgery, especially for severe chronic obstructive pulmonary disease, obstructive sleep apnea, and morbid obesity. Given our meta-analysis's relevant possible biases, we required more adequately powered and better-designed RCT studies with long-term follow-up to reach a firmer conclusion.
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Affiliation(s)
- Changjiao Sun
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Xiaolin Ji
- Department of Anesthesia, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Xiaofei Zhang
- Department of Clinical Epidemiology and Biostatistics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Qi Ma
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Peng Yu
- Department of Orthopedic, Wuhan University of Science and Technology Hospital, Qingling Street, Hongshan District, Wuhan, 102218, China
| | - Xu Cai
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China.
| | - Huadong Yang
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China.
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Patel MS, Abboud JA, Sethi PM. Perioperative pain management for shoulder surgery: evolving techniques. J Shoulder Elbow Surg 2020; 29:e416-e433. [PMID: 32844751 DOI: 10.1016/j.jse.2020.04.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 02/08/2023]
Abstract
Improving management of postoperative pain following shoulder surgery is vital for optimizing patient outcomes, length of stay, and decreasing addiction to narcotic medications. Multimodal analgesia (ie, controlling pain via multiple different analgesic methods with differing mechanisms) is an ever-evolving approach to enhancing pain control perioperatively after shoulder surgery. With a variety of options for the shoulder surgeon to turn to, this article succinctly reviews the pros and cons of each approach and proposes a potential pain management algorithm.
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Affiliation(s)
- Manan S Patel
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
| | - Joseph A Abboud
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Paul M Sethi
- Orthopaedic & Neurosurgery Specialists, Greenwich, CT, USA
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Turcotte JJ, Thomas DM, Lashgari CJ, Zaidi S, York JJ, Gelfand JM, Petre BM, Redziniak DE. Early postoperative pain and opioid consumption after arthroscopic shoulder surgery with or without open subpectoral biceps tenodesis and interscalene block. J Orthop 2020; 22:372-376. [PMID: 32952329 DOI: 10.1016/j.jor.2020.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/23/2020] [Indexed: 11/29/2022] Open
Abstract
Objective The addition of open subpectoral biceps tenodesis to arthroscopic shoulder surgery with interscalene block has been anecdotally observed to result in increased postoperative pain. This study aims to evaluate the impact of tenodesis on early postoperative pain and recovery. Methods A retrospective review of patients undergoing arthroscopic shoulder surgery with general anesthesia and interscalene block was conducted. Results Patients undergoing tenodesis experienced longer OR time, pain numeric rating scale (NRS), and consumed more morphine milligram equivalents (MME) in PACU. After controlling for confounding factors, tenodesis was significantly associated with increased opioid MME consumption in the PACU (β = 1.045, p = .028) and last PACU pain NRS (β = 0.541, p = .009). Conclusion Overall, pain scores and narcotic consumption were low after surgery, making these differences potentially clinically insignificant. Further study is required to evaluate whether these trends are consistent among this population.
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Affiliation(s)
| | | | | | - Sohail Zaidi
- Division of Anesthesiology, Anne Arundel Medical Center, United States
| | - James J York
- Anne Arundel Medical Center Orthopedics, United States
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Lim JA, Sung SY, Lee JH, Lee SY, Kwak SG, Ryu T, Roh WS. Comparison of ultrasound-guided and nerve stimulator-guided interscalene blocks as a sole anesthesia in shoulder arthroscopic rotator cuff repair: A retrospective study. Medicine (Baltimore) 2020; 99:e21684. [PMID: 32871884 PMCID: PMC7458219 DOI: 10.1097/md.0000000000021684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Ultrasound-guided interscalene block (US-ISB) and nerve stimulator-guided interscalene block (NS-ISB) have both been commonly used for anesthesia in shoulder arthroscopic surgery.This study aims to compare which method provides surgical block as a sole anesthesia. In this retrospective study, 1158 patients who underwent shoulder arthroscopic rotator cuff tear repair surgery under ISB between October 2002 and March 2018 were classified into either the US-ISB or NS-ISB anesthesia groups. Demographic and anesthetic characteristics and intraoperative medications were analyzed after propensity score matching and compared between the 2 groups.There was a 0.5% rate of conversion to general anesthesia in the US-ISB group and a 6.7% rate in the NS-ISB group (P < .001). The volume of local anesthetics used for ISB was 29.7 ± 8.9 mL in the US-ISB group versus 38.1 ± 4.8 mL in the NS-ISB group (P < .001). The intraoperative use of analgesics and sedatives such as fentanyl, midazolam and propofol in combination was significantly lowered in the US-ISB group (P < .001).US-ISB is a more effective and safer approach for providing intense block to NS-ISB because it can decrease the incidence of conversion to general anesthesia and reduce the use of analgesics and sedatives during arthroscopic shoulder surgery.
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Affiliation(s)
- Jung A. Lim
- Department of Anesthesiology and Pain Medicine, Catholic University of Daegu School of Medicine
| | | | - Ji Hyeon Lee
- Department of Anesthesiology and Pain Medicine, Catholic University of Daegu School of Medicine
| | - So Young Lee
- Department of Anesthesiology and Pain Medicine, Catholic University of Daegu School of Medicine
| | - Sang Gyu Kwak
- Department of Medical Statistics, School of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Taeha Ryu
- Department of Anesthesiology and Pain Medicine, Catholic University of Daegu School of Medicine
| | - Woon Seok Roh
- Department of Anesthesiology and Pain Medicine, Catholic University of Daegu School of Medicine
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Retrospective review of open and arthroscopic repair of anterosuperior rotator cuff tears with subscapularis involvement: a single surgeon's experience. J Shoulder Elbow Surg 2020; 29:893-897. [PMID: 31812587 DOI: 10.1016/j.jse.2019.09.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND There have been conflicting results when comparing outcomes of open vs. arthroscopic anterosuperior rotator cuff repairs with subscapularis involvement. The purpose of this study was to evaluate midterm outcome differences and complications following open vs. arthroscopic repair of rotator cuff tears involving the subscapularis by a single surgeon. METHODS This was a retrospective review of 57 rotator cuff repairs involving the subscapularis performed by a single surgeon over a 10-year period. During this time, the surgeon transitioned from open to arthroscopic repair. Preoperative and postoperative range of motion, lift-off test, belly press test, and American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment form scores were measured. RESULTS Eighteen patients had open procedures and 39 had arthroscopic repair. The mean preoperative ASES score for the open group was 39 and postoperatively was 79. The mean preoperative ASES score for the arthroscopic group was 44 and improved to 80 postoperatively. There was no significant difference in score or change in score between the 2 groups (P > .05). There was only 1 complication. It occurred in the open group and was a superficial wound dehiscence. CONCLUSIONS This study demonstrated no outcome differences between open and arthroscopic rotator cuff repair involving the subscapularis, even with large subscapularis tears. Both techniques significantly improved shoulder function. Arthroscopic and open rotator cuff repairs including the subscapularis are relatively safe procedures, and either technique is an acceptable option.
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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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12
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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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Patient Complications after Interscalene Block: A Retrospective Comparison of Liposomal Bupivacaine to Nonliposomal Bupivacaine. Anesthesiol Res Pract 2020; 2020:6704303. [PMID: 32280340 PMCID: PMC7139877 DOI: 10.1155/2020/6704303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/17/2020] [Accepted: 02/27/2020] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to investigate if the addition of liposome bupivacaine (LB) to an interscalene block (ISB) had an effect on the number of patients with surgical- or block-related complications. Methods This was a single-center retrospective chart view performed by identifying patients who received an ISB from January 1, 2014, through April 26, 2018, at the University of Minnesota. 1,518 patients were identified who received an ISB (LB = 784, nonliposomal bupivacaine = 734). Patients were divided into two groups those who did receive liposome bupivacaine in their ISB and those who did not receive liposome bupivacaine in their ISB. Medical records were individually reviewed for surgical procedure, block medications, complications related to the block or surgical procedure, phone calls to the healthcare system for issues related to opioids or pain within 3 and within 30 days, readmissions within 30 days, and emergency room visits for complications within 3 and 30 days. Results There was no significant difference in the number of patients with surgical or anesthetic complications. Only phone calls for pain within 3 days were significantly different. The LB group had 3.2% of patients call compared to 5.6% in the nonliposomal bupivacaine group (aOR = 1.71 (95% CI: 1.04–2.87), p=0.036). We found no significant difference in any of the other secondary outcomes. Conclusions The use of LB in an ISB demonstrated no significant difference compared to nonliposomal bupivacaine in numbers of complications, emergency room visits, and readmissions.
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Addition of 100 mg of Tramadol to 40 mL of 0.5% Ropivacaine for Interscalene Brachial Plexus Block Improves Postoperative Analgesia in Patients Undergoing Shoulder Surgeries as Compared to Ropivacaine Alone-A Randomized Controlled Study. ACTA ACUST UNITED AC 2019; 55:medicina55070399. [PMID: 31340565 PMCID: PMC6681507 DOI: 10.3390/medicina55070399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/11/2019] [Accepted: 07/19/2019] [Indexed: 12/13/2022]
Abstract
Background and objectives: Brachial plexus block is commonly used in shoulder surgery, as it provides satisfactory surgical conditions and adequate postoperative pain control. However, there are contradictory reports regarding the addition of tramadol to the injected regional anesthetic solution. We performed a prospective randomized study to evaluate the effectiveness of tramadol as an adjuvant to ropivacaine during interscalene brachial plexus block and assess its impact on the opioid consumption and the early postoperative pain in patients that underwent shoulder surgery. Materials and Methods: Eighty patients scheduled for elective shoulder surgery and anesthesia via interscalene brachial plexus block were randomly divided into two groups. In group A (n = 40), a solution of 40 mL of ropivacaine 0.5% and 2 mL (100 mg) of tramadol was administered during the brachial plexus block, while in group B (n = 40), a solution of 40 mL of ropivacaine 0.5% and 2 mL NaCl 0.9% (placebo) was administered. The effectiveness and duration of sensory and motor blocks were recorded in both groups. The sensory block was assessed recording the loss of sensation to pin prick test over the skin distribution of the axillary, radial, and musculocutaneous nerves. The motor block was assessed using the modified 3-point Bromage score (0–2 points). Cumulative morphine consumption and pain, using the Visual Analog Scale (VAS), were evaluated in both groups at 2, 4, 8, and 24 h after surgery. Results: Sensory block onset was achieved earlier in group A than in group B (5.21 ± 3.15 minutes (min) vs. 7.1 ± 4.51 min, p = 0.029). The motor block onset was similar between the two groups (13.08 ± 6.23 min vs. 13.28 ± 6.59 min; p = 0.932). The duration of the sensory block was longer in group A as compared to group B (13 ± 2.3 h vs. 12 ± 2.8 h; p = 0.013). The duration of the motor block did not present any difference between the groups (10 ± 2.2 h vs. 10 ± 2.8 h; p = 0.308). Differences in morphine administration were not significant at 2, 4, and 8 h, however, morphine consumption was found to be decreased in group A 24 h postoperatively A (p = 0.04). The values of VAS were similar at 2, 4, and 8 h, however, they were lower in group A at 24 h (p < 0.013). Conclusions: Combined regional administration of tramadol and ropivacaine during interscalene brachial plexus block improves the time of onset and the duration of the sensory block, while it is associated with reduced morphine consumption during the first 24 h after shoulder surgery.
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Gurger M, Ozer AB. A comparison of continuous interscalene block versus general anesthesia alone on the functional outcomes of the patients undergoing arthroscopic rotator cuff repair. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1659-1666. [PMID: 31243560 DOI: 10.1007/s00590-019-02482-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/21/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE The aim of this prospective and randomized study was to compare the effects of general anesthesia to the combination of general anesthesia and continuous interscalene block on postoperative pain and functional outcomes in patients undergoing arthroscopic rotator cuff repair. METHODS This study included a total of 85 patients aged 45-74 years, who were scheduled for elective arthroscopic rotator cuff repair. One group consists of patients who underwent only general anesthesia (GA, N = 43), and the other group consists of patients who underwent a combination of continuous interscalene brachial plexus block and general anesthesia (CISB + GA, N = 42). Pain levels of the patients were evaluated postoperatively by a visual analog scale. Shoulder function was evaluated preoperatively and postoperatively using the Constant score. RESULTS Patients in the CISB + GA group had lower postoperative visual analog scores and less additional analgesic needs during the early postoperative period than those in the GA group. Constant scores of the patients in the CISB + GA group at postoperative week 6 were higher than those in the GA group. Evaluation of the functional outcomes at 6 months postoperatively showed that there were no significant differences between the two groups. CONCLUSION Although CISB significantly improved postoperative pain control and early (in the first 6 weeks) functional outcomes following arthroscopic rotator cuff repair, there was no significant difference between the CISB group and CISB + GA group at 6 months. LEVEL OF EVIDENCE Level II, Randomized Controlled Trial, Treatment Study.
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Affiliation(s)
- Murat Gurger
- Department of Orthopedics and Traumatology, Faculty of Medicine, Firat University Hospital, 23190, Elazig, Turkey.
| | - Ayse Belin Ozer
- Department of Anesthesiology, Faculty of Medicine, Inonu University Hospital, 44280, Malatya, Turkey
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Interscalene versus supraclavicular plexus block for the prevention of postoperative pain after shoulder surgery. Eur J Anaesthesiol 2019; 36:427-435. [DOI: 10.1097/eja.0000000000000988] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rotator cuff repair is more painful than other arthroscopic shoulder procedures. Arch Orthop Trauma Surg 2019; 139:669-674. [PMID: 30560289 DOI: 10.1007/s00402-018-3100-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Indexed: 02/09/2023]
Abstract
AIM To evaluate the influence of the specific procedure performed and other variables on the intensity of acute postoperative pain following outpatient shoulder arthroscopy. METHODS One hundred patients undergoing outpatient shoulder arthroscopy under single-shot interscalene block plus general anaesthesia were prospectively studied. Acetaminophen with ibuprofen was prescribed for postoperative pain control and tramadol HCl as rescue medication. Patients scored pain intensity at 2, 6, and 24 h postoperatively. The influence of the surgical procedure, age, gender, surgery duration, and irrigation volume used on the intensity of postoperative pain was studied. RESULTS Five patients were excluded due to ineffective block or protocol deviation. Among the 95 remaining patients, 51 underwent rotator cuff tear repair, 25 shoulder stabilisation, and 19 subacromial decompression. While there were no differences at 2 and 6 h after surgery, pain intensity was significantly higher among those undergoing rotator cuff tear repair (5.2, 1-10) at 24 h compared to stabilisation (4.1, 1-8) or subacromial decompression (5, 1-8) (p < 0.0001). No association was found between pain intensity and other variables. CONCLUSION A higher degree of acute postoperative pain should be expected in patients undergoing arthroscopic rotator cuff tear repair compared to other arthroscopic shoulder procedures, and additional pain treatment is recommended.
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Sun H, Li S, Wang K, Zhou J, Wu G, Fang S, Sun X. Do liposomal bupivacaine infiltration and interscalene nerve block provide similar pain relief after total shoulder arthroplasty: a systematic review and meta-analysis. J Pain Res 2018; 11:1889-1900. [PMID: 30271195 PMCID: PMC6151095 DOI: 10.2147/jpr.s177716] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Controversy still exists regarding the efficiency and safety of liposomal bupivacaine (LB) vs interscalene nerve block (INB) for pain management after total shoulder arthroplasty (TSA). The aim of the present meta-analysis was to perform a relatively credible and overall assessment to compare the efficiency and safety of LB-based infiltration vs INB for pain management after TSA. METHODS The PubMed, Cochrane Library, Web of Science, and EMBASE were systematically searched. Only studies published up to March 2018 comparing LB vs INB for pain control after TSA were included. The primary outcome extracted from the studies was postoperative pain score at different periods. The secondary outcomes included total opioid consumption, length of hospital stay, and complications. RESULTS Seven studies with 707 patients were included in this study. No statistically significant difference was observed between the LB and INB groups in pain scores at 8 hours, 12 hours, 24 hours, postoperative day (POD) 1, and POD 2. The two groups also showed comparable total opioid consumption at POD 0, POD 1, POD 2, and length of hospital stay. The LB group had a significantly higher pain score at 4 hours (standard mean difference =0.65, 95% CI=0.07 to 1.24, P=0.03) but a lower occurrence rate of complications than did the INB group (OR =0.51, 95% CI=0.28 to 0.91, P=0.02). CONCLUSION This meta-analysis revealed that INB provides excellent analgesic effects within 4 hours after TSA, while patients treated with LB infiltration experienced significantly less occurrence rate of complications after TSA. In general, both approaches provide similar overall pain relief and have similar opioid consumption after TSA, with no significant difference in the length of hospital stay. Nevertheless, more high-quality randomized controlled trails with long-term follow-up are still required to make the final conclusion.
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Affiliation(s)
- Han Sun
- Department of Articular Orthopaedics, The Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu, China,
| | - Shuxiang Li
- Department of Articular Orthopaedics, The Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu, China,
| | - Kun Wang
- Department of Articular Orthopaedics, The Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu, China,
| | - Jian Zhou
- Department of Articular Orthopaedics, The Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu, China,
| | - Guofeng Wu
- Department of Articular Orthopaedics, The Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu, China,
| | - Sheng Fang
- Department of Articular Orthopaedics, The Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu, China,
| | - Xiaoliang Sun
- Department of Articular Orthopaedics, The Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu, China,
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Holbrook HS, Parker BR. Peripheral Nerve Injury Following Interscalene Blocks: A Systematic Review to Guide Orthopedic Surgeons. Orthopedics 2018; 41:e598-e606. [PMID: 30125041 DOI: 10.3928/01477447-20180815-04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 12/18/2017] [Indexed: 02/03/2023]
Abstract
The purpose of this review was to determine the incidence and duration of peripheral neurologic symptoms following interscalene blocks for shoulder surgery. Three databases were reviewed for subjective and objective injuries by guidance modality and delivery method. The incidence of neurologic injuries following single site injection interscalene blocks, 3.16%, was significantly less than the 5.24% incidence for continuous catheter infusion interscalene blocks. Less than 0.51% of peripheral neurologic symptoms persisted beyond 1 year for both groups. There is a notable risk of injury following interscalene blocks by all modes of guidance and anesthetic technique, but only a small percentage of injuries persist. [Orthopedics. 2018; 41(5):e598-e606.].
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Kim JH, Koh HJ, Kim DK, Lee HJ, Kwon KH, Lee KY, Kim YS. Interscalene brachial plexus bolus block versus patient-controlled interscalene indwelling catheter analgesia for the first 48 hours after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2018; 27:1243-1250. [PMID: 29605659 DOI: 10.1016/j.jse.2018.02.048] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 02/01/2018] [Accepted: 02/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND We sought to compare the efficacy of interscalene brachial plexus bolus blockade (IBPBB) and patient-controlled interscalene indwelling catheter analgesia (PCIA) for postoperative pain management within 48 hours postoperatively in patients undergoing arthroscopic rotator cuff repairs (ARCR). METHODS Patients undergoing ARCR were randomized into 3 groups by postoperative analgesia method. The IBPBB group received a mixed solution of 16 mL of 0.75% ropivacaine and 4 mL of 2% lidocaine as a bolus postoperatively. The PCIA group received a 10-mL bolus solution of 0.75% ropivacaine (4 mL) and 5% dextrose water (6 mL) just after the operation and continuous infusion of this solution. The control received only meperidine as needed, 12.5 mg, intravenously. Visual analog scale (VAS) pain scores were evaluated for the first 48 hours postoperatively. RESULTS For the first 2 hours postoperatively, VAS scores in the IBPBB group were significantly lower than in the PCIA group and control group, but at 12 and 24 hours postoperatively, VAS scores of the IBPBB group were significantly higher than the PCIA group (P < .05). At 48 hours postoperatively, there was no significant difference in VAS scores among the 3 groups (P = .169). The method of analgesia was the only factor affecting pain scores at 24 hours postoperatively (P < .05). CONCLUSIONS IBPBB provided effective immediate postoperative analgesia until 6 hours postoperatively. Especially until postoperative 2 hours, the VAS pain score was less than 1 point in the IBPBB group; however, there was significant rebound pain at 12 hours after surgery. During the first 24 hours postoperatively, PCIA reduced postoperative pain without rebound pain. Surgeons should choose methods for control of postoperative pain considering the advantages and disadvantages of each analgesic method.
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Affiliation(s)
- Jong-Ho Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Jung Koh
- Departiment of Anesthesiology and Pain, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Kyu Kim
- Departiment of Anesthesiology and Pain, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | - Hyo-Jin Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Hyun Kwon
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
| | - Kwang-Yeol Lee
- Department of Orthopedic Surgery, Seoul Nanuri Hospital, Seoul, Republic of Korea
| | - Yang-Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea.
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Recovery after shoulder arthroscopy: Inpatient versus outpatient management. Orthop Traumatol Surg Res 2018; 104:39-43. [PMID: 29233760 DOI: 10.1016/j.otsr.2017.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 10/05/2017] [Accepted: 10/10/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Shoulder arthroscopy is particularly suited to outpatient surgery, thanks to advances in anesthetic and analgesic techniques. The main goal of this study was to compare postoperative recovery after shoulder arthroscopy between outpatient and inpatient management. HYPOTHESIS There is no difference in functional recovery between inpatient and outpatient management. MATERIALS AND METHOD A single-center, single-operator prospective study was conducted. Both groups received patient-controlled analgesia via an interscalene catheter. The inclusion criterion was shoulder arthroscopy for rotator cuff tendinopathy. The choice between inpatient and outpatient management was left to the patient. The study endpoint was postoperative recovery assessed on QOR-15 at days 1, 2, 3, 4 and 7 and on Quick-DASH at 6 weeks. RESULTS Forty-nine patients were included, divided into 2 groups. The outpatient (OP) and inpatient (IP) groups were comparable. Reconstructive surgery accounted for 54% of cases in OP versus 62% in IP. There was no significant difference in recovery in the first postoperative days (QOR-15) or at 6 weeks (Quick-DASH) (p>0.05). Pain on visual analog scale (VAS) was significantly greater in OP after discharge home. DISCUSSION No significant difference in postoperative recovery was observed between groups. Nevertheless, pain management and patient information for outpatients need improving. LEVEL OF EVIDENCE II, comparative study.
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Weller WJ, Azzam MG, Smith RA, Azar FM, Throckmorton TW. Liposomal Bupivacaine Mixture Has Similar Pain Relief and Significantly Fewer Complications at Less Cost Compared to Indwelling Interscalene Catheter in Total Shoulder Arthroplasty. J Arthroplasty 2017; 32:3557-3562. [PMID: 28390888 DOI: 10.1016/j.arth.2017.03.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/20/2017] [Accepted: 03/07/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The efficacy and costs of indwelling interscalene catheter (ISC) and liposomal bupivacaine (LBC), with and without adjunctive medications, in patients with primary shoulder arthroplasty are a source of current debate. METHODS In 214 arthroplasties, 156 patients had ISC and 58 had LBC injections that were mixed with morphine, ketorolac, and 0.5% bupivacaine with epinephrine. Charts were reviewed for visual analog scale pain scores, oral morphine equivalent (OME) usage, major complications, and costs. RESULTS Visual analog scale scores were not significantly different at 24 hours or at 2, 6, and 12 weeks. Average OME consumption at 24 hours was significantly more with LBC, but was not significantly different at 12 weeks. Relative risk of a major complication was nearly 4 times higher with ISC than with LBC. The average cost for the LBC mixture was $289.04, and for ISC, including equipment and anesthesia fees, was $1559.42. CONCLUSION The intraoperative LBC mixture provided equivalent pain relief with significantly fewer major complications and at markedly lower cost than ISC. LBC required almost twice as much OME to attain the same level of pain relief at 24 hours, but there was no significant difference in the cumulative amount of outpatient narcotic use.
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Affiliation(s)
- William J Weller
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee
| | - Michael G Azzam
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee
| | - Richard A Smith
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee
| | - Frederick M Azar
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee
| | - Thomas W Throckmorton
- Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee
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Guo C, Ma J, Ma X, Lu B, Wang Y, Tian A, Sun L, Wang Y, Dong B, Teng Y. Supraclavicular block versus interscalene brachial plexus block for shoulder surgery: A meta-analysis of clinical control trials. Int J Surg 2017; 45:85-91. [DOI: 10.1016/j.ijsu.2017.07.098] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/17/2017] [Accepted: 07/25/2017] [Indexed: 12/01/2022]
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Thompson M, Simonds R, Clinger B, Kobulnicky K, Sima AP, Lahaye L, Boardman ND. Continuous versus single shot brachial plexus block and their relationship to discharge barriers and length of stay. J Shoulder Elbow Surg 2017; 26:656-661. [PMID: 28277258 DOI: 10.1016/j.jse.2016.09.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/22/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Brachial plexus block has been associated with improved pain control and decreased length of stay in patients undergoing upper extremity arthroplasty. Continuous delivery is associated with a shorter length of stay; however, comparisons to single-shot delivery in this setting are scarce. As the paradigm shifts to outpatient arthroplasty in the era of bundled payments, there exists a strong impetus to identify the most effective mode of analgesia associated with the least risk to patients. METHODS This is a retrospective review of 697 patients undergoing upper extremity arthroplasty comparing the rate of complications and incidence of potential barriers to discharge and length of stay of patients receiving continuous vs. single-shot perineural brachial plexus block. RESULTS No difference was observed in the complication rate between indwelling (n = 63 [12%]) and single-shot groups (n = 30 [17%]; P = .137). The majority of complications were pulmonary, 72% attributable to oxygen desaturation. The indwelling catheter group had 1.61 times higher odds (95% confidence interval, 1.07-2.42; P = .023) of exhibiting any potential barrier to discharge and exhibited a longer length of stay (P = .002). CONCLUSION There was no demonstrated disparity in the rate of complications associated with single-shot vs. continuous brachial plexus block. However, the continuous indwelling catheter was associated with an increased incidence of potential barriers to discharge and an increased length of stay compared with patients receiving single-shot regional anesthesia.
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Affiliation(s)
- Matthew Thompson
- Department of Orthopaedic Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA.
| | - Robert Simonds
- School of Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Bryce Clinger
- School of Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Kristen Kobulnicky
- Department of Orthopaedic Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Adam P Sima
- Department of Biostatistics, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Laura Lahaye
- Department of Anesthesia, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - N Douglas Boardman
- Department of Orthopaedic Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
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Webb BG, Sallay PI, McMurray SD, Misamore GW. Comparison of Interscalene Brachial Plexus Block Performed With and Without Steroids. Orthopedics 2016; 39:e1100-e1103. [PMID: 27575034 DOI: 10.3928/01477447-20160819-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/15/2016] [Indexed: 02/03/2023]
Abstract
This prospective comparative clinical study was performed to evaluate the effect of triamcinolone when added to bupivacaine during brachial plexus blockade in patients undergoing shoulder surgery. Interscalene brachial plexus blocks were performed on 910 patients before shoulder surgery. Of the patients, 574 were randomly allocated to receive steroids added to the injected local anesthetic and 336 patients received local anesthetic without steroids. All patients were followed prospectively to evaluate the rate of successful anesthesia, duration of anesthesia, side effects of the block, adverse events, and persistent neurologic complications associated with interscalene brachial plexus block. Patients who received steroids had statistically longer pain relief than those who did not receive steroids (P<.001). No difference was found in adverse events, complications, or side effects. Compared with blocks performed without steroids, a statistically longer duration of block analgesia occurred with the addition of steroids to the local anesthetic solution during brachial plexus blockade. Rates of side effects, adverse events, and persistent neurologic complications were similar between the groups. [Orthopedics. 2016; 39(6):e1100-e1103.].
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Danninger T, Stundner O, Rasul R, Brummett CM, Mazumdar M, Gerner P, Memtsoudis SG. Factors associated with hospital admission after rotator cuff repair: the role of peripheral nerve blockade. J Clin Anesth 2015; 27:566-73. [DOI: 10.1016/j.jclinane.2015.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 01/30/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
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The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine. Reg Anesth Pain Med 2015; 40:401-30. [DOI: 10.1097/aap.0000000000000286] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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The effect of ondansetron in preventing the hypotensive bradycardic events during shoulder arthroscopy done under interscalene block in the sitting position. EGYPTIAN JOURNAL OF ANAESTHESIA 2014. [DOI: 10.1016/j.egja.2014.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Interscalene plexus block versus general anaesthesia for shoulder surgery: a randomized controlled study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:255-61. [DOI: 10.1007/s00590-014-1483-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 05/05/2014] [Indexed: 11/27/2022]
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Busfield BT, Romero DM, Korshad D, Kharrazi FD. Subacromial pain pump use is safe after arthroscopic rotator cuff repair. J Orthop 2014; 11:64-7. [PMID: 25104887 DOI: 10.1016/j.jor.2014.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 04/15/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Intra-articular pain pumps with local anesthetics have been implicated as a potential cause of post-arthroscopic glenohumeral chondrolysis (PAGCL) of the shoulder. In short-term studies, subacromial pain pump use is effective and safe without association with PAGCL. Patients with full thickness rotator cuff tears may be at high risk of PAGCL given disruption of the tendinous integrity which may allow intra-articular infusion of local anesthetics. We hypothesized that subacromial pain pump use after arthroscopic rotator cuff repair would not result in PAGCL. METHODS We analyzed a consecutive series of 34 patients treated with subacromial pain pump placement after arthroscopic rotator cuff repair and subacromial decompression for full thickness rotator cuff tears. Thirty patients met inclusion criteria of greater than 12-month follow-up with an average age of 51 (28-68). All patients had the subacromial pain pumps placed under arthroscopic visualization and infused 0.25% bupivacaine without epinephrine at 2 cc/h for 48 h. All patients had clinical examinations and radiographic studies performed more than 1 year after surgery. RESULTS Patients had an average rotator cuff size of 1.6 cm and fixation was performed with bioabsorbable suture anchors. All patients had at least 150° of abduction and forward flexion at latest follow-up without palpable crepitus and no patients had any evidence of joint space narrowing on post-operative radiographs. CONCLUSION Subacromial pain pump use after arthroscopic rotator cuff repair is safe. Despite probable lack of a water-tight seal from repair, there were no cases of PAGCL. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Denise M Romero
- Bay Area Surgical Specialists, Orthopedic Surgery, Walnut Creek, CA 94598, USA
| | - Daniel Korshad
- Kerlan-Jobe Orthopaedic Clinic, Los Angeles, CA 90045, USA
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Ramirez MA, Ramirez JM, Murthi AM. Multimodal local infiltration analgesia in total shoulder replacement. Pain Manag 2014; 3:253-5. [PMID: 24654808 DOI: 10.2217/pmt.13.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Miguel A Ramirez
- Department of Orthopedic Surgery, MedStar Union Memorial Hospital, 333 North Calvert Street, Suite 400, Baltimore, MD 21218, USA
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Ovesen J, Falstie-Jensen T, Christensen C. A Comparison of Subacromial Bursae Block, Suprascapular Nerve Block and Interscalene Brachial Plexus Block after Arthroscopic Shoulder Surgery. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/pst.2014.23017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Han SS, Lee YH, Oh JH, Aminzai S, Kim SH. Randomized, controlled trial of multimodal shoulder injection or intravenous patient-controlled analgesia after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2013; 21:2877-83. [PMID: 22990950 DOI: 10.1007/s00167-012-2202-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 08/30/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of this study was to compare the effect of postoperative pain control and adverse effects of intravenous patient-controlled analgesia (IV PCA) and multimodal shoulder injection after arthroscopic rotator cuff repair. METHODS Seventy patients scheduled for elective arthroscopic rotator cuff repair were prospectively randomized to receive either IV PCA or multimodal shoulder injections. Postoperative pain, nausea, vomiting, and other adverse effects were assessed at 2, 6, 12, 24, and 48 h after surgery. Use of rescue analgesics and antiemetics, level of satisfaction, and cost for both modalities were recorded. RESULTS Pain was better controlled in the multimodal shoulder injection group at 2 h postoperatively (P = 0.001). However, the use of additional analgesics was greater in the multimodal shoulder injection group during 12-48 h after surgery (P < 0.001). The incidence of nausea within 12-24 h after surgery in the multimodal shoulder injection group (5.7 %) was less significant compared with that in the IV PCA group (31.4 %, P = 0.012), but no difference in overall incidence of the use of rescue antiemetics was observed between the groups (n.s.). No differences in adverse effects were noted between the groups. Patient satisfaction also showed no differences (n.s.). Costs required for both modalities were $20.3 for the multimodal shoulder injection and $157.8 for the IV PCA. CONCLUSIONS Multimodal shoulder injection is a safe and effective modality for management of pain after arthroscopic rotator cuff repair. Considering the expense and need of special devices for IV PCA, multimodal shoulder injection may be an effective and safe alternative to IV PCA for postoperative analgesia after arthroscopic rotator cuff repair.
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Affiliation(s)
- Sun Sook Han
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea,
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Moore DD, Maerz T, Anderson K. Shoulder surgeons' perceptions of interscalene nerve blocks and a review of complications rates in the literature. PHYSICIAN SPORTSMED 2013; 41:77-84. [PMID: 24113705 DOI: 10.3810/psm.2013.09.2026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Interscalene nerve blocks (ISBs) have been shown to be an effective option for regional anesthesia in shoulder surgery. Our study presents survey results of shoulder surgeons' perceptions of ISBs and a literature summary of complications rates with ISB use. METHODS A survey addressing demographics, preferences, treatment patterns, risks/benefits, and patient recommendations regarding the use of ISBs was created. Respondents were also asked whether they would elect an ISB if personally undergoing shoulder surgery, and results of other questions were stratified based on this personal preference. The survey was administered electronically to all members of the American Shoulder and Elbow Surgeons. A literature review of ISB-related complication rates was compiled from 13 studies of shoulder surgery using ISB. RESULTS Of all respondents, 58.7% would elect a single-shot ISB, 15.0% would elect a continuous catheter, and 26.3% would not elect the use of an ISB if undergoing shoulder surgery. Respondents from a university hospital were 1.44 times more likely to elect any ISB than respondents from a non-university hospital. Improved post-operative pain control was considered the greatest benefit, whereas persistent neuropathy was considered the greatest risk of ISB use. Of the respondents, 76.1% would recommend use of ISB to their patients undergoing shoulder surgery. Our literature review yielded 13 applicable studies that utilized a total of 6243 ISBs, with data resulting in a 0.35% major complication rate and an 11.32% minor complication rate in patients. CONCLUSION The majority of shoulder surgeons surveyed in our study would elect to have a single-shot interscalene nerve block if undergoing shoulder surgery themselves, indicating that ISB use is considered a safe and effective anesthetic option among shoulder surgeon specialists.
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Affiliation(s)
- Drew D Moore
- Department of Orthopaedic Surgery, Beaumont Health System, Royal Oak, MI
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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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Colvin AC, Egorova N, Harrison AK, Moskowitz A, Flatow EL. National trends in rotator cuff repair. J Bone Joint Surg Am 2012; 94:227-33. [PMID: 22298054 PMCID: PMC3262185 DOI: 10.2106/jbjs.j.00739] [Citation(s) in RCA: 497] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recent publications suggest that arthroscopic and open rotator cuff repairs have had comparable clinical results, although each technique has distinct advantages and disadvantages. National hospital and ambulatory surgery databases were reviewed to identify practice patterns for rotator cuff repair. METHODS The rates of medical visits for rotator cuff pathology, and the rates of open and arthroscopic rotator cuff repair, were examined for the years 1996 and 2006 in the United States. The national incidence of rotator cuff repairs and related data were obtained from inpatient (National Hospital Discharge Survey, NHDS) and ambulatory surgery (National Survey of Ambulatory Surgery, NSAS) databases. These databases were queried with use of International Classification of Diseases, Ninth Revision (ICD-9) procedure codes for arthroscopic (ICD-9 codes 83.63 and 80.21) and open (code 83.63 without code 80.21) rotator cuff repair. We also examined where the surgery was performed (inpatient versus ambulatory surgery center) and characteristics of the patients, including age, sex, and comorbidities. RESULTS The unadjusted volume of all rotator cuff repairs increased 141% in the decade from 1996 to 2006. The unadjusted number of arthroscopic procedures increased by 600% while open repairs increased by only 34% during this time interval. There was a significant shift from inpatient to outpatient surgery (p < 0.001). CONCLUSIONS The increase in national rates of rotator cuff repair over the last decade has been dramatic, particularly for arthroscopic assisted repair.
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Affiliation(s)
- Alexis Chiang Colvin
- Department of Orthopaedic Surgery, Mount Sinai School of Medicine, 5 East 98th Street, Box 1188, New York, NY 10029. E-mail address for A.C. Colvin:
| | - Natalia Egorova
- Icahn Medical Institute, Department of Health Evidence and Policy, Mount Sinai School of Medicine, 1425 Madison Avenue, 2nd Floor, New York, NY 10029
| | - Alicia K. Harrison
- Department of Orthopaedic Surgery, Mount Sinai School of Medicine, 5 East 98th Street, Box 1188, New York, NY 10029. E-mail address for A.C. Colvin:
| | - Alan Moskowitz
- Icahn Medical Institute, Department of Health Evidence and Policy, Mount Sinai School of Medicine, 1425 Madison Avenue, 2nd Floor, New York, NY 10029
| | - Evan L. Flatow
- Department of Orthopaedic Surgery, Mount Sinai School of Medicine, 5 East 98th Street, Box 1188, New York, NY 10029. E-mail address for A.C. Colvin:
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Lee HY, Kim SH, So KY, Kim DJ. Effects of interscalene brachial plexus block to intra-operative hemodynamics and postoperative pain for arthroscopic shoulder surgery. Korean J Anesthesiol 2012; 62:30-4. [PMID: 22323951 PMCID: PMC3272526 DOI: 10.4097/kjae.2012.62.1.30] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 08/25/2011] [Accepted: 08/25/2011] [Indexed: 11/10/2022] Open
Abstract
Background Although arthroscopic shoulder surgery is less invasive and painful than open shoulder surgery, it can often cause intra-operative hemodynamic instability and severe post-operative pain. This study was conducted to investigate the efficacy of the interscalene brachial plexus block (IBPB) on intra-operative hemodynamic changes and post-operative pain during arthroscopic shoulder surgery. Methods After institutional review board approval, 50 consecutive patients that had undergone arthroscopic shoulder surgery under general anesthesia were randomly assigned to one of two groups to evaluate intra-operative hemodynamic changes and post-operative pain control. Group 1 patients received an IBPB with 10 ml of normal saline guided by a nerve stimulator before induction, and Group 2 patients received 10 ml of 0.5% ropivacaine hydrochloride with the same technique. The heart rate and systolic and diastolic blood pressures were recorded before the incision and 1, 3, 5, 10, and 20 minutes after the incision. Pre-operative and post-operative pain was evaluated with a visual analog scale 1, 3, 6, 12, and 24 hours after surgery. The patients were given tramadol as a rescue medication option. The total volume of tramadol that was injected was also evaluated over the same intervals. Results Group 2 showed significantly lower systolic and diastolic blood pressures and heart rates intra-operatively compared to Group 1 (P < 0.05). The visual analog scale pain scores, except at 24 hours after surgery, were significantly lower in Group 2 (P < 0.05). The total tramadol consumption significantly reduced in Group 2 (P < 0.05). Conclusions IBPB effectively controlled the hemodynamic changes that occurred during arthroscopic shoulder surgery as well as post-operative pain.
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Affiliation(s)
- Hyun-Young Lee
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea
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Regional Anesthesia Procedures for Shoulder and Upper Arm Surgery Upper Extremity Update—2005 to Present. Int Anesthesiol Clin 2012; 50:26-46. [DOI: 10.1097/aia.0b013e31821a0284] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rains DD, Rooke GA, Wahl CJ. Pathomechanisms and complications related to patient positioning and anesthesia during shoulder arthroscopy. Arthroscopy 2011; 27:532-41. [PMID: 21186092 DOI: 10.1016/j.arthro.2010.09.008] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 08/31/2010] [Accepted: 09/09/2010] [Indexed: 02/02/2023]
Abstract
The lateral decubitus and beach-chair positions each offer unique benefits to the shoulder surgeon with respect to visualization, efficiency, and ease during arthroscopic shoulder procedures. The purpose of this article was to comprehensively review the reports and studies documenting independent and dependent complications related to patient positioning and anesthesia during arthroscopic shoulder surgery. The lateral decubitus position has been associated with the potential for peripheral neurapraxia, brachial plexopathy, direct nerve injury, and airway compromise. The beach-chair position has been associated with cervical neurapraxia, pneumothorax, and the potential for end-organ hypoperfusion injuries (when deliberate hypotension is used). Potentially concerning are hypotensive bradycardic events, which may be relatively common in association with the use of epinephrine-containing interscalene anesthetics in beach chair-positioned patients. Irrigant complications (fluid spread, ventricular tachycardia) are avoidable risks not unique to either specific position. Although minor transient anesthetic- and position-related complications (neurapraxia, hypotension) may occur in as many 10% to 30% of patients, major complications such as end-organ damage or permanent impairments are exceedingly rare. Regardless of position, complications are almost uniformly avoidable if surgeon and anesthetist exercise care and prudent attention to position and anesthetic choices. The purpose of this article is to review the potential for position- and anesthesia-related complications and acquaint the shoulder surgeon with the proposed pathophysiologic mechanisms that can lead to them.
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Affiliation(s)
- Derek D Rains
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, 98195-4060, USA
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A prospective analysis of interscalene brachial plexus blocks performed under general anesthesia. J Shoulder Elbow Surg 2011; 20:308-14. [PMID: 20708419 DOI: 10.1016/j.jse.2010.04.043] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 04/20/2010] [Accepted: 04/25/2010] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this prospective study was to assess the safety and efficacy of interscalene brachial plexus block anesthesia when performed on patients who were anesthetized with a general anesthetic prior to the performance of the block. METHODS Patients were assessed postoperatively through surveys, interviews, and physical examinations to document block success, duration of anesthesia, block side effects, and persistent neurological complications. Nine-hundred fifty-one patients were available for the analysis. RESULTS The overall block success rate was 97% and the mean duration of anesthesia provided by the blocks was 23.9 hours. Immediate postoperative block side effects occurred in 16% (142 of 910), persistent neurological complications occurred in 4.4% (40 of 910) of patients, and long-term neurologic complications occurred in 0.8% (8 of 910). CONCLUSION Our study results suggest that the rates of success and complications associated with the performance of interscalene block regional anesthesia performed after induction of general anesthesia are similar to the results demonstrated in prior studies in which brachial plexus block was performed on nonanesthetized patients. Although significant complications were not common, this procedure is not without risk and can result in long-term neurologic complications.
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Liu SS, Gordon MA, Shaw PM, Wilfred S, Shetty T, Yadeau JT. A prospective clinical registry of ultrasound-guided regional anesthesia for ambulatory shoulder surgery. Anesth Analg 2010; 111:617-23. [PMID: 20686013 DOI: 10.1213/ane.0b013e3181ea5f5d] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND There is a lack of clinical registries to document efficacy and safety of ultrasound-guided regional anesthesia. Interscalene blocks are effective for shoulder arthroscopy, and ultrasound guidance may reduce risk. Furthermore, ultrasound-guided supraclavicular block is a novel approach for shoulder anesthesia that may have less risk for neurological symptoms than interscalene block. METHODS One thousand one hundred sixty-nine patients undergoing ultrasound-guided regional anesthesia for ambulatory shoulder arthroscopy were enrolled in our prospective registry. Standardized perioperative data were collected including a preoperative neurological screening tool. Either interscalene or supraclavicular block was performed at the discretion of the clinical team. Standardized follow-up was performed in the postanesthesia care unit and at 1 week. Postoperative neurological symptoms (PONS) were assessed at the 1-week follow-up with the same screening tool by a blinded neurologist. RESULTS Ultrasound-guided interscalene (n = 515) and supraclavicular (n = 654) blocks had excellent anesthetic success (99.8%; 95% confidence interval [CI], 99.4%-99.9%) with 0% (95% CI, 0%-0.3%) incidence of vascular puncture or intravascular injection. The incidence of hoarseness in the postanesthesia care unit was significantly less with supraclavicular (22% with 95% CI, 19%-26%) than interscalene block (31% with 95% CI, 27%-35%). The incidence of dyspnea was similar (7% for supraclavicular vs 10% with interscalene). No patient had a clinically apparent pneumothorax. The incidence of PONS was very low (0.4% with 95% CI, 0.1%-1%), and there was a 0% (95% CI, 0%-0.3%) incidence of permanent nerve injury. CONCLUSIONS Ultrasound-guided interscalene and supraclavicular blocks are effective and safe for shoulder arthroscopy. Temporary and permanent PONS is uncommon.
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Affiliation(s)
- Spencer S Liu
- Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021, USA.
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Seo KC, Park JS, Roh WS. Factors contributing to episodes of bradycardia hypotension during shoulder arthroscopic surgery in the sitting position after interscalene block. Korean J Anesthesiol 2010; 58:38-44. [PMID: 20498810 PMCID: PMC2872894 DOI: 10.4097/kjae.2010.58.1.38] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 10/09/2009] [Accepted: 10/20/2009] [Indexed: 11/29/2022] Open
Abstract
Background Arthroscopic shoulder surgery has been performed in the sitting position under interscalene block (ISB). Bradycardia hypotension (BH) episodes have a reported incidence of 13-29% in this setting. We performed a retrospective study to investigate contributing factors to the occurrence of BH episodes. Methods According to BH episodes, we divided 63 patients into two groups: BH group (n = 13) and non-BH group (n = 50). Anesthetic records and block data sheets were reviewed for demographic data, intraoperative medications, sites of ISB, use of epinephrine in local anesthetics, degree of sensory blockade, and percent change of heart rate or systolic blood pressure (SBP). Statistical analysis was done using Chi square test and Student's t-test. Results There were no significant differences in the use of epinephrine in local anesthetics between the two groups. The location of ISB site was different between the two groups in that there were relatively more right-sided ISBs in the BH group than in the non-BH group (P = 0.048). The degree of sensory blockade was lower, but not significantly, in the C8 and T1 dermatomes of the BH group than in the non-BH group (P = 0.060 and 0.077, respectively). There was a relatively higher incidence of fentanyl supplementation in the BH group than in the non-BH group (P = 0.000). Conclusions These results suggest that right ISB and perioperative supplementation of fentanyl due to incomplete block are possible contributing factors to the occurrence of BH episodes in the sitting position during shoulder surgery using ISB.
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Affiliation(s)
- Kwi Chu Seo
- Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea
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Smith HM, Duncan CM, Hebl JR. Clinical utility of low-volume ultrasound-guided interscalene blockade: contraindications reconsidered. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1251-1258. [PMID: 19710225 DOI: 10.7863/jum.2009.28.9.1251] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this series is to describe cases in which ultrasound guidance was used to allow patients to receive the benefits of regional anesthesia while safely circumventing traditional contraindications to interscalene blockade (ISB). METHODS Targeted low-volume ISB was performed in 3 patients in whom this procedure would typically be contraindicated because of phrenic nerve blockade or risk of local anesthetic toxicity. A patient with severe respiratory dysfunction, a patient undergoing bilateral shoulder surgery, and a patient requiring awake fiberoptic intubation underwent low-volume ultrasound-guided ISB. The ultrasound technique involved the use a low local anesthetic volume, anatomic identification of the brachial plexus trunk, needle placement opposite the phrenic nerve position, and control over local anesthetic spread. RESULTS In both patients in whom diaphragmatic paralysis was a concern, postoperative respiratory parameters indicated successful regional analgesia without evidence of phrenic nerve blockade. In the patient requiring an additional regional anesthetic procedure, ISB was performed with a local anesthetic volume low enough to avoid exceeding toxic safety thresholds. CONCLUSIONS Although further studies are warranted, we report on 3 cases in which ultrasound guidance was used to allow patients to receive the benefits of regional anesthesia while safely avoiding standard contraindications to ISB. Ultrasound technology may allow providers to perform low-volume brachial plexus blockade while avoiding issues related to phrenic nerve blockade and systemic local anesthetic toxicity.
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Affiliation(s)
- Hugh M Smith
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN 55905 USA.
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Busfield BT, Romero DM. Pain pump use after shoulder arthroscopy as a cause of glenohumeral chondrolysis. Arthroscopy 2009; 25:647-52. [PMID: 19501296 DOI: 10.1016/j.arthro.2009.01.019] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 01/28/2009] [Accepted: 01/28/2009] [Indexed: 02/02/2023]
Abstract
Shoulder arthroscopy has become a routine outpatient surgery. Pain control is a limiting factor for patient discharge after surgery, and several modalities are used to provide continued analgesia postoperatively. Regional anesthetic blocks and shoulder pain pumps are common methods to provide short-term pain control. Shoulder pain pumps can be used either in the subacromial space or within the glenohumeral joint. Several clinical studies suggested--which was confirmed by a bovine and rabbit cartilage study--that there is significant chondrotoxicity from bupivacaine, a local anesthetic commonly used in pain pumps. Postarthroscopic glenohumeral chondrolysis is a noninfectious entity associated with factors including use of radiofrequency thermal instruments and intra-articular pain pumps that administer bupivacaine, but there have been no cases reported with subacromial pain pump placement. Treatment options are difficult in a young patient with postarthroscopic glenohumeral chondrolysis, and understanding the literature with regard to risk factors is paramount to counseling patients and preventing this devastating complication.
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MESH Headings
- Adjuvants, Anesthesia/administration & dosage
- Adjuvants, Anesthesia/adverse effects
- Adolescent
- Adult
- Analgesia, Patient-Controlled/instrumentation
- Analgesia, Patient-Controlled/methods
- Anesthetics, Local/administration & dosage
- Anesthetics, Local/adverse effects
- Animals
- Arthroscopy/adverse effects
- Bupivacaine/administration & dosage
- Bupivacaine/adverse effects
- Cartilage Diseases/chemically induced
- Cartilage, Articular/drug effects
- Cartilage, Articular/pathology
- Catheter Ablation/adverse effects
- Cattle
- Chondrocytes/drug effects
- Chondrocytes/pathology
- Epinephrine/administration & dosage
- Epinephrine/adverse effects
- Humans
- Infusion Pumps, Implantable/adverse effects
- Infusions, Parenteral
- Injections, Intra-Articular
- Joint Capsule/surgery
- Pain, Postoperative/drug therapy
- Rabbits
- Rotator Cuff/surgery
- Shoulder/surgery
- Shoulder Joint/drug effects
- Shoulder Joint/pathology
- Young Adult
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Affiliation(s)
- Benjamin T Busfield
- Arthritis, Orthopedic, and Sports Medical Center, Glendale, California 91206, USA.
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Abstract
PURPOSE OF REVIEW To review the recently published peer-reviewed literature involving regional anesthesia and analgesia in patients at home. RECENT FINDINGS The potential benefits and risks of regional anesthesia and analgesia at home are pertinent queries, and increased data regarding these topics are rapidly becoming available. Of particular interest is the use of continuous peripheral nerve blocks at home and their potential effect upon hospitalization duration and recovery profile. SUMMARY Advantages of regional techniques include site-specific anesthesia and decreased postoperative opioid use. For shoulder surgeries, the interscalene block provides effective analgesia with minimal complications, whereas the impact and risks of intraarticular injections remain unclear. Perineural catheters are an analgesic option that offer improved pain relief among other benefits. They are now being used at home in both adult and pediatric populations.
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Busfield BT, Lee GH, Carrillo M, Ortega R, Kharrazi FD. Subacromial pain pump use with arthroscopic shoulder surgery: a short-term prospective study of complications in 583 patients. J Shoulder Elbow Surg 2008; 17:860-2. [PMID: 18657448 DOI: 10.1016/j.jse.2008.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 03/20/2008] [Accepted: 03/24/2008] [Indexed: 02/01/2023]
Abstract
Pain pumps containing local anesthetics, with or without opioids, can be used for perioperative analgesia after arthroscopic shoulder surgery to reduce pain. Although several smaller studies have demonstrated the analgesic properties, no large series to date has reported the short-term complication rate of subacromial pain pumps. We prospectively studied (2005 to 2007) 583 patients who underwent arthroscopic shoulder surgery at a single outpatient surgery center and had intraoperative placement of a pain pump catheter into the subacromial space. Patients had at least 1 month of follow-up. No patient received perioperative brachial plexus regional anesthesia. There were no cases of infection, internal catheter breakage, pump failure, or hospital admission for pain control. The only complication was external catheter breakage that occurred when a patient attempted to remove the pump without removing the tape fastening the catheter at the skin. Subacromial pain pumps used for arthroscopic shoulder procedures are safe in the short-term.
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Kweon KS, Yang HJ, Gill HJ, Seol JH, Kim JH, Lee JY, Kim MK. Interscalene brachial plexus block: depth and angle from the skin insertion point to the brachial plexus and to C 6-7intervertebral foramen. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.55.5.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Kyoung Seok Kweon
- Department of Anesthesiology and Pain Medicine, College of Medicine, Pocheon CHA University, Seongnam, Korea
| | - Hyeon Jeong Yang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Pocheon CHA University, Seongnam, Korea
| | - Hyun Jue Gill
- Department of Anesthesiology and Pain Medicine, College of Medicine, Pocheon CHA University, Seongnam, Korea
| | - Jung Ho Seol
- Department of Anesthesiology and Pain Medicine, College of Medicine, Pocheon CHA University, Seongnam, Korea
| | - Ji Hyoung Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Pocheon CHA University, Seongnam, Korea
| | - Jong Yeon Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Pocheon CHA University, Seongnam, Korea
| | - Min Ku Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Pocheon CHA University, Seongnam, Korea
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