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Pehlivan SS, Gergin OO, Aksu R, Guney A, Guler E, Yildiz K. A Randomized Comparison Between Interscalene and Combined Interscalene-Suprascapular Blocks for Arthroscopic Shoulder Surgery: A Prospective Clinical Study. J Pain Res 2024; 17:335-343. [PMID: 38292756 PMCID: PMC10824609 DOI: 10.2147/jpr.s435685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
Background To compare the analgesic effect of ISB with a combination of ISB-SSNB and patients who were given opioids with PCA without block in adult patients undergoing shoulder surgery, as measured by opioid consumption and pain intensity in the first 24 hours postoperatively. Methods Ninety patients who underwent shoulder surgery were randomly divided into three groups. Group I in which ISB was performed and patient-controlled analgesia (PCA) was inserted, Group II with; ISB and SSNB combined, and PCA was inserted, and Group III where; only PCA was used. Visual analog scale (VAS) pain scores at the second, fourth, sixth, 12th, and 24th hours, morphine consumption, additional analgesic requirement, and patient satisfaction were evaluated. Results Compared with Group III, the VAS pain score was significantly lower in Group I and Group II at 2, 4, 6, 12, and 24 hours postoperatively. In Group I, the VAS score at rest at the 6th hour was found to be higher than in Group II. The 24-hour total morphine consumption was higher in the control group than in Group I and Group II. The satisfaction score of the control group was lower than Group I and Group II. Conclusion The combined application of ISB and SSNB block is beneficial in shoulder surgery to provide both intraoperative and postoperative analgesia and opioid consumption. Level of Evidence Level I; Randomized Controlled Trial; Treatment Study.
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Affiliation(s)
- Sibel Seckin Pehlivan
- Department of Anaesthesiology and Reanimation, Erciyes University, Medical Faculty, Kayseri, Turkey
| | - Ozlem Oz Gergin
- Department of Anaesthesiology and Reanimation, Erciyes University, Medical Faculty, Kayseri, Turkey
| | - Recep Aksu
- Department of Anaesthesiology and Reanimation, Erciyes University, Medical Faculty, Kayseri, Turkey
| | - Ahmet Guney
- Department of Orthopedic Surgery, Erciyes University, Medical Faculty, Kayseri, Turkey
| | - Emel Guler
- Department of Pain, Cumhuriyet University, Medical Faculty, Sivas, Turkey
| | - Karamehmet Yildiz
- Department of Anaesthesiology and Reanimation, Erciyes University, Medical Faculty, Kayseri, Turkey
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Maurya I, Garg R, Jain VK, Iyengar KP, Vaishya R. Perioperative anaesthetic considerations for rotator cuff repair surgeries: A current concept review. J Clin Orthop Trauma 2021; 17:65-71. [PMID: 33717972 PMCID: PMC7920097 DOI: 10.1016/j.jcot.2021.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 02/07/2023] Open
Abstract
Surgeries for Rotator Cuff (RC) pathologies are required for either trauma or degenerative related aetiologies. Various surgical techniques from open to arthroscopic repair, are being undertaken by orthopaedic surgeons. Peri-operative anaesthetic management of the patients undergoing rotator cuff repair requires understanding the surgical procedure and patient status for optimal anaesthetic planning. Such management mandates a thorough pre-operative evaluation, including clinical history, examination, and relevant investigations. Patients with acute trauma associated Rotator Cuff (RC) tears should be assessed for visceral injuries using appropriate injury evaluation systems before such repairs. On the other hand, patients with degenerative tears tend to be older with associated comorbidities. Hence pre-operative optimisation is necessary according to risk stratification. Anaesthetic techniques for Rotator Cuff (RC) surgery include general anaesthesia or regional anaesthesia. These are individualised according to patient assessment and surgical procedure planned. Knowledge of relevant surgical anatomy is essential for intra-operative, and post-operative neural blockade techniques since optimal peri-operative analgesia improve overall patient recovery. The occurrence of a peri-operative complication should be recognised as timely management improves the patient-related surgical outcomes. We describe the relevance of surgical anatomy, the effect of patient positioning, irrigating fluids, various anaesthetic techniques and an overview of regional and medical interventions to manage pain in patients undergoing for Rotator Cuff (RC) surgery.
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Affiliation(s)
- Indubala Maurya
- Department of Anaesthesiology, Super Speciality Cancer Institute & Hospital, C.G. City, Sultanpur Road, Lucknow, Uttar Pradesh, India
| | - Rakesh Garg
- Additional Professor of Anaesthesiology, Critical Care and Pain, Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
- Corresponding author. Department of Orthopaedics, Atal Bihari Vajpayee institute of medical sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Karthikeyan P. Iyengar
- Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, 110076, New Delhi, India
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Yilmaz E. A prospective, comparative study of subacromial corticosteroid injection and subacromial corticosteroid injection plus suprascapular nerve block in patients with shoulder impingement syndrome. Arch Orthop Trauma Surg 2021; 141:733-741. [PMID: 32356170 DOI: 10.1007/s00402-020-03455-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Efforts are recently focused on the management of shoulder impingement syndrome (SIS) with a conservative and targeted approach because of its psychosocial impact, reduction in the quality of life, the cost to the economy and its negative effect on daily activities. Therefore, many studies have been designed to evaluate and compare the effectiveness of different treatments. The main purpose of this study was to identify the effect of combination of subacromial corticosteroid injection (SCI) and suprascapular nerve block (SSNB) on shoulder impingement syndrome (SIS). MATERIALS AND METHODS 66 patients with SIS were randomly divided into two groups (33 patients per group): Group 1: SCI; Group 2: SCI plus SSNB. The estimation of the severity of pain by the visual analogue scale (VAS) and shoulder disability using quick DASH (Disabilities of the Arm, Shoulder and Hand) were assessed at baseline and 1, 3 months post-injection. RESULTS The mean age of patients was 55.55 ± 10.42 years in Group 1 and 57.24 ± 12.75 years in Group 2. In steroid group, pre- and post-treatment (at 1 and 3 months) VAS/quickDASH scores were 8.64 ± 0.99/78.03 ± 9.24, 2.09 ± 0.84/15.58 ± 7.23 and 3.06 ± 1.12/25.06 ± 8.74, respectively. In steroid plus SSNB group, pre- and post-treatment (at 1 and 3 months) VAS/quickDASH scores were 8.45 ± 0.90/75.15 ± 9.86, 1.24 ± 0.43/10.88 ± 2.14 and 1.51 ± 0.56/15.51 ± 5.04, respectively. Both treatment groups showed a significant relief of pain at 1 and 3 months post-injection (p < 0.05). However, the VAS and quickDASH scores at 1 and 3 months were significantly lower in Group 2 versus Group 1 (p < 0.05). CONCLUSION The combination of SCI and SSNB seems to produce the long-term effect in pain relief and functional improvement.
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Affiliation(s)
- Ebru Yilmaz
- Department of Physical Medicine and Rehabilitation, Kocaeli Government Hospital, Gunes Street 41300, Kocaeli, Turkey.
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Kim JY, Kang MW, Lee HW, Noh KC. Suprascapular Nerve Block Is an Effective Pain Control Method in Patients Undergoing Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial. Orthop J Sports Med 2021; 9:2325967120970906. [PMID: 33553443 PMCID: PMC7841678 DOI: 10.1177/2325967120970906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/01/2020] [Indexed: 12/22/2022] Open
Abstract
Background Effective pain control in patients who have undergone arthroscopic rotator cuff surgery improves functional recovery and early mobilization. Interscalene blocks (ISBs), a widely used approach, are safe and provide fast pain relief; however, they are associated with complications. Another pain management strategy is the use of a suprascapular nerve block (SSNB). Hypothesis We hypothesized that indwelling SSNB catheters are a more effective pain control method than single-shot ISBs. We also hypothesized that indwelling SSNB catheters will reduce the level of rebound pain and the demand for opioid analgesics. Study Design Randomized controlled trial; Level of evidence, 1. Methods Included in this study were 93 patients who underwent arthroscopic rotator cuff surgery between May 2012 and January 2019. These patients were assigned to either the indwelling SSNB catheter group, the single-shot ISB group, or the control (sham/placebo) group (31 patients per group). Level of pain was measured with a visual analog scale (VAS; 0 to 10 [worst pain]) on the day of the operation. The preoperative VAS score was recorded at 6 AM on the day of operation, and the postoperative scores were recorded at 1, 8, and 16 hours after surgery and then every 8 hours until postoperative day 3. Results The VAS pain scores were lower in the SSNB and ISB groups than in the control group up to postoperative hour (POH) 8, with the most significant difference at POH 8. At POH 1 and POH 8, the mean VAS scores for each group were 2.29 and 1.74 (SSNB), 2.59 and 2.50 (ISB), and 3.42 and 4.48 (control), respectively. VAS scores in the SSNB and ISB groups were consistently <3, compared with a mean VAS score of 3.1 ± 1.58 in the control group (P < .001). Compared with the ISB group, the SSNB group had significantly fewer side effects such as rebound pain duration as well as lower VAS scores (P < .001). Conclusion VAS scores were the lowest in the indwelling SSNB catheter group, with the most pronounced between-group difference in VAS scores at POH 8. Severity and recurring frequency of pain were lower in the indwelling SSNB catheter group than in the single-shot ISB group.
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Affiliation(s)
- Jung Youn Kim
- Shoulder & Elbow Clinic, Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea
| | - Min Wook Kang
- Shoulder & Elbow Clinic, Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea
| | - Ho Won Lee
- Shoulder & Elbow Clinic, Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea
| | - Kyu Cheol Noh
- Shoulder & Elbow Clinic, Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea
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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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A prospective study of two methods of analgesia in shoulder arthroscopic procedures as day case surgery. J Clin Orthop Trauma 2020; 11:S368-S371. [PMID: 32523295 PMCID: PMC7275286 DOI: 10.1016/j.jcot.2019.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 06/08/2019] [Accepted: 06/08/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND & PURPOSE The recent advances in anaesthesia and analgesia have significantly improved the early recovery and effective post-operative pain control in day care surgery e.g. shoulder arthroscopic procedures. Adequate analgesia improves the early rehabilitation for a better outcome. We prospectively evaluated the post-operative pain relief following the two methods of analgesia i.e. regional Inter-scalene block (ISB) vs Intra-articular (IA) injection using 0.5% Chirocaine in various therapeutic arthroscopic shoulder procedures. METHODS A prospective comparative study was performed on a group of 105 patients (ASA grade I or II) who underwent the following procedures at two different hospitals: diagnostic arthroscopy, subacromial decompression (SAD) alone, SAD in combination with mini open cuff repairs or distal clavicle excision, anterior stabilization (Bankart's repair) and inferior capsular shift. A successful Inter-scalene block (0.5% Chirocaine-30mls) preceded the general anaesthesia (Group 1-52 patients). Local intra-articular infiltration (0.5% Chirocaine - 20 mls) was given postoperatively (Group 2-53 patients). Post operatively visual analogue scores (VAS) from 0 (no pain) to 10 (severe pain) were assessed in post-anaesthesia care unit (PACU), at 4hrs, at 24hrs and at 48 h. The amount of morphine consumption for the first 2 days after surgery was recorded. RESULTS Patient characteristics were similar in both groups at both the hospitals. The median postoperative pain score of VAS <3 was observed in both groups. Significant difference (p < 0.0001) was observed in the VAS scores between the two groups at all the time intervals. The mean length of adequate sensory block in group 1 was significantly higher than in group 2 [20.5 h: 4.2 h] (p < 0.001). The mean analgesic (morphine) consumption was lower in Group 1 as compared to Group 2 [4.6 mg/24 h: 18.8mg/24 h](p < 0.0001). Bone shaving procedures e.g. SAD, SAD + Rotator Cuff repair, SAD + Lateral clavicular excision required significantly higher analgesia in both groups compared to the soft tissue procedures. CONCLUSION Single dose ISB provided longer and effective postoperative analgesia. The bone shaving procedures required more analgesia in IA Group as compared to ISB Group.
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Seering MS, Bayman EO, Wong CA, Ranganath YS, Marian AA. Comparison of the effect of three different adjuvants on the analgesic duration of single injection interscalene brachial plexus block: a prospective, randomized, triple blinded clinical trial. Reg Anesth Pain Med 2019; 44:rapm-2018-100201. [PMID: 31308262 DOI: 10.1136/rapm-2018-100201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 06/12/2019] [Accepted: 06/17/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVES Use of regional anesthesia can result in faster recovery and better patient satisfaction. Addition of perineural adjuncts to local anesthetics may improve the duration of analgesia, but there is a paucity of data comparing them in a single randomized trial. We compared the effects of three adjuncts clonidine, dexamethasone, and buprenorphine, on the duration of analgesia of interscalene brachial plexus block. METHODS 160 patients, undergoing elective shoulder surgery, were randomized to four groups to receive an interscalene block with one of the following solutions: ropivacaine alone, ropivacaine with clonidine 75 µg, ropivacaine with dexamethasone 8 mg, or ropivacaine with buprenorphine 300 µg. The primary outcome variable was the duration of analgesia; secondary outcome measures were time to onset of the block, and the duration of sensory and motor blocks. RESULTS There was no statistically significant difference in the total analgesia time among the four groups; p=0.11. The pairwise comparison in analgesic time and 99% CI were: control versus clonidine (-1.94 hours (-7.33 to 3.12)), control versus dexamethasone (-4.16 hours (-9.50 to 0.58)) and control versus buprenorphine (-1.1 hours (-5.34 to 3.23)). There was no differences in block set-up time, or total sensory and motor block duration among the groups. CONCLUSION There was no significant improvement in the duration of analgesia with addition of any of the three adjuncts to interscalene blocks. However, there was a larger than expected variability in patient response, hence the study may have been underpowered for the primary outcome.
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Affiliation(s)
- Melinda S Seering
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Emine O Bayman
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Cynthia A Wong
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | - Anil A Marian
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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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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Reilly S, Sahni M, Jagannathan S. Supraclavicular or interscalene brachial plexus block for rotator cuff repair? Anaesthesia 2016; 71:1492-1493. [DOI: 10.1111/anae.13654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S. Reilly
- University Hospital Birmingham NHS Foundation Trust; Birmingham UK
| | - M. Sahni
- University Hospital Birmingham NHS Foundation Trust; Birmingham UK
| | - S. Jagannathan
- University Hospital Birmingham NHS Foundation Trust; Birmingham UK
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