Comparison of interscalene brachial plexus block and intra-articular local anesthetic administration on postoperative pain management in arthroscopic shoulder surgery

Aksu, Recep; Biçer, Cihangir; Ülgey, Ayşe; Bayram, Adnan; Güneş, İbrahim; Güney, Ahmet; Yıldırım, Mustafa; Gökahmetoğlu, Günhan; Yildiz, Karamehmet

doi:10.1016/j.bjane.2014.06.005

Cited by 11 publications

(23 citation statements)

References 12 publications

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“…[11,12] For example in the PHERICUS trial the additional analgesic requirements of the supraclavicular and interscalene block groups were similar, but this is probably due to analgesic protocol differences between the studies. [11,12] The total morphine consumption of the interscalene group in the present study was 18.95±9.2 mg which quite similar to the value found by Aksu et al [13] Although they used lower doses and concentrations of bupivacaine (20 ml 0.25%) the patients in their interscalene group consumed 16.3±7.8 mg of morphine, we believe that this difference may be due to operation type differences and the use of different PCA protocols.…”

Section: Discussionsupporting

confidence: 89%

Postoperative Analgesia after Arthroscopic Shoulder Surgery: A Comparison of Single Shot Interscalene Block with Single Shot Supraclavicular Block

Koltka

Büget²,

Bingül³

et al. 2017

Agri

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SummaryObjectives: In arthroscopic rotator cuff surgery for postoperative analgesia opioids, nonsteroid analgesics, and local anesthetics can be used. This study aimed to compare the effectiveness, additional analgesic requirements, patients satisfaction, and complications of single-shot interscalene and supraclavicular blocks. Methods: After obtaining the ethics committee's approval and informed consent, 50 ASA I-II patients were randomized to either the interscalene (GISB) or supraclavicular (GSCB) group. Preoperatively, patients received an ultrasonography-guided block using 30 ml of 0.5% bupivacaine. In the postoperative period, morphine patient-controlled analgesia was administered as a 0.3-mg/h basal dose and 1-mg bolus dose, with a 20-min lockout time. Postoperative visual analog scale (VAS; 0-10 cm) scores of the patients were evaluated at 4, 8, 12, and 24 h postoperatively; additional analgesic requirements, adverse effects, and complications were recorded. Patient satisfaction (PS) scores were evaluated after 24 h. Results: VAS scores at 4 h were lower in the GSCB group than in the GISB group, and the VAS scores at 8, 12, and 24 h were lower in the GISB group than in the GSCB group, with no statistical significance. Additional analgesic requirements was 28% in the GISB group and 68% in the GSCB group (p < 0.05). Total morphine consumption was lower in the GISB group than in the GSCB group (18.95±9.2 mg vs. 30.6 ± 9.6 mg; p < 0.001). PS scores were higher in the GISB group than in the GSCB group (7.0±1.0 vs. 6.1±0.9; p < 0.01). Adverse effects and complication rates were similar in both the groups. In GISB group, seven patients (28%) had nausea/vomiting, whereas in the GSCB group, 12 patients (48%) had nausea/vomiting. This difference was statistically insignificant. Conclusion: Supraclavicular block can be considered as an alternative to interscalene block for arthroscopic shoulder surgery.Keywords: shoulder surgery, interscalene block, supraclavicular block, postoperative analgesia Özet Amaç: Artroskopik omuz cerrahisi hastalarında postoperatif analjezik olarak opioidler, nonsteroid analjezikler ve lokal anestetikler kullanılabilir. Çalışmamızda tek doz interskalen blokla tek doz supraklavikular bloğun postoperatif analjezik etkinliklerini karşılaştırılması amaçlandı. Gereç ve Yöntem: Etik kurul ve hastalardan izin alındıktan sonra interskalen (GİSB) veya supraklavikular blok (GSKB) uygulanması için kontrendikasyonu bulunmayan ASA I-II 50 hasta randomize olarak ikiye ayrıldı. İki gruba da preoperatif dönemde ultrason eşliğinde blok yapılarak 30 ml %0.5 bupivakain uygulandı. Postoperatif dönemde intravenöz morfin 0.3 mgr/saat infüzyon, 1 mgr bolus doz ve kilitli kalma süresi 20 dakika olacak şekilde hasta kontrollü analjezi uygulandı. Hastaların postoperatif vizuel analog skala (VAS: 0-10 cm) değerleri 4., 8., 12. ve 24. saatlerde sorgulandı, ek analjezik ihtiyaçları ve tekniğe bağlı yan etki ve komplikasyonlar kaydedildi. 24 saat sonunda hasta memnuniyeti (HM) sorgulandı. Bulgular: VAS değerlerine bak...

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Section: Discussionsupporting

confidence: 89%

Postoperative Analgesia after Arthroscopic Shoulder Surgery: A Comparison of Single Shot Interscalene Block with Single Shot Supraclavicular Block

Koltka

Büget²,

Bingül³

et al. 2017

Agri

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“…The time to first pain or analgesic request was reported in 11 studies and was the primary outcome in 5 studies [ 10 , 16 – 19 ] (one of which also had analgesic consumption as a primary outcome [ 10 ]). In 8 studies, a rescue analgesic was given based on pain scale ratings [ 10 – 12 , 15 , 17 , 20 – 22 ].…”

Section: Resultsmentioning

confidence: 99%

“…The VAS, NRS, and Likert scale all used similar minimum anchors such as “no pain”. To describe higher pain levels, the scales used 14 different anchors in total ( Figure 2 ) with “worst pain imaginable” [ 11 , 12 , 15 , 26 , 36 , 38 , 43 , 48 , 51 , 54 ] being the preferred anchor. The second most frequent anchor was “worst pain” [ 10 , 28 , 33 , 34 ] and then successively “most severe pain imaginable” [ 19 , 20 , 37 ], “severe pain” [ 18 , 32 , 46 ], and “worst possible pain” [ 29 , 41 , 47 ].…”

Section: Resultsmentioning

confidence: 99%

“…The number of pain recordings decreased from POD2 to POD6 with a small increase in POD7. The time points in POD1 were specified in 32 of the included studies and represented 28 different time points ( Figure 5 ) [ 10 – 12 , 14 , 19 – 21 , 23 , 26 – 28 , 30 , 31 , 33 – 38 , 43 , 46 – 52 , 54 – 57 , 59 ]. The most frequently used time points were: post-anaesthesia care unit, 1, 2, 4, 6, 8, 12, and 24 hours postoperatively.…”

Section: Resultsmentioning

confidence: 99%

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Acute postoperative pain after arthroscopic rotator cuff surgery: A review of methods of pain assessment

Rasmussen

Nikolajsen

Bjørnholdt

2018

SICOT-J

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Introduction: Pain can be severe during the first days after arthroscopic surgery, and acute pain is an important outcome in clinical trials of surgical technique or anaesthetic strategy. A standardized, validated method of assessing acute postoperative pain would improve the quality of clinical studies, and facilitate systematic reviews and meta-analyses. A step on the way towards this standard is to investigate the methods most commonly used in recent literature.Methods: PubMed and CINAHL databases were searched, including studies of arthroscopic rotator cuff surgery with a primary pain-related outcome during the first postoperative week, published in English from 2012 to 2017.Results: A total of 47 studies were included, all measuring pain intensity using a pain rating scale. Most frequently used was the visual analogue scale using the anchors “no pain” and “worst pain imaginable”, with recordings at 1, 2, 4, 6, 8, 12, and 24 hours postoperatively. A total of 34 studies recorded analgesic consumption, usually as average cumulated consumption in mg. Time to first analgesic request or first pain were recorded in 11 studies, and 4 different starting points were used.Discussion: This review describes the currently most common methods of assessing acute postoperative pain in clinical trials of arthroscopic shoulder surgery involving rotator cuff repair, and the large variety of methods applied. Based on this study and international guidelines, several recommendations on how to measure and report postoperative pain outcomes in future trials are proposed.

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“…[2] Traditional postoperative pain control has centered on the use of parenteral narcotics in the hospital, which have well-known side effects of respiratory depression, somnolence, and inconsistent pain relief. [3,4] Efficacy pain control after surgery may improve pain control and decreased the length of stay. A common method of pain control after shoulder surgery involves regional anesthesia with the use of an interscalene nerve block.…”

Section: Introductionmentioning

confidence: 99%

Liposomal bupivacaine versus interscalene nerve block for pain control after shoulder arthroplasty

Zeng

Zong

2017

Medicine

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Background:Postoperative pain control after total shoulder arthroplasty (TSA) can be challenging. Liposomal bupivacaine and interscalene nerve block are 2 common pain control protocol for TSA patients. However, whether liposomal bupivacaine was superior than interscalene nerve block was unknown. This meta-analysis aimed to illustrate the efficacy liposomal bupivacaine versus interscalene nerve block for pain control in patients undergoing TSA.Methods:In May 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google database. Data on patients prepared for TSA in studies that compared liposomal bupivacaine versus interscalene nerve block were retrieved. The endpoints were the visual analogue scale (VAS) at 4 hours, 8 hours, 12 hours, 24 hours, and 2 weeks, total morphine consumption at 24 hours, and the length of hospital stay. Software of Stata 12.0 was used for pooling the final outcomes.Results:Five clinical studies with 573 patients (liposomal bupivacaine group = 239, interscalene nerve block group = 334) were ultimately included in the meta-analysis. There was no significant difference between the VAS at 4 hours, 8 hours, and 2 weeks between liposomal bupivacaine group and interscalene nerve block group (P > .05). Compared with interscalene nerve block group, liposomal bupivacaine was associated with a reduction of VAS score at 12 hours, 24 hours by appropriately 3.31 points and 6.42 points respectively on a 100-point VAS. Furthermore, liposomal bupivacaine was associated with a significantly reduction of the length of hospital stay by appropriately by 0.16 days compared with interscalene nerve block group.Conclusion:Current meta-analysis indicates that compared with interscalene nerve block, liposomal bupivacaine had comparative effectiveness on reducing both pain scores and the length of hospital stay. However, studies with more patients and better-designed methods are needed to establish the optimal regimen and the safety of liposomal bupivacaine in TSA patients.

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Comparison of interscalene brachial plexus block and intra-articular local anesthetic administration on postoperative pain management in arthroscopic shoulder surgery

Abstract: Interscalene brachial plexus block was found to be more effective than intra-articular local anesthetic injection for postoperative analgesia.

Cited by 11 publications

References 12 publications

Postoperative Analgesia after Arthroscopic Shoulder Surgery: A Comparison of Single Shot Interscalene Block with Single Shot Supraclavicular Block

Postoperative Analgesia after Arthroscopic Shoulder Surgery: A Comparison of Single Shot Interscalene Block with Single Shot Supraclavicular Block

Acute postoperative pain after arthroscopic rotator cuff surgery: A review of methods of pain assessment

Liposomal bupivacaine versus interscalene nerve block for pain control after shoulder arthroplasty

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