Safety and Cost-Effectiveness of Interscalene Brachial Plexus Block With Sedation in Reverse Total Shoulder Replacement

Abstract

Aims To investigate the safety and cost-effectiveness of interscalene brachial plexus block/regional anaesthesia (ISB-RA) in patients undergoing reverse total shoulder replacement. Patients and methods This retrospective study included 15 patients with symptomatic rotator cuff arthropathy who underwent reverse total shoulder arthroplasty (rTSA) under ISB-RA without general anaesthesia in the beach chair position from 2010 to 2018. The mean patient age was 77 years (range 59-82 years). Patients had associated medical comorbidities: American Society of Anesthesiologists (ASA) grade 2-4. Assessed parameters were: duration of anaesthesia, intra-operative systolic blood pressure variation, sedation and vasopressor use, duration of post-operative recovery, recovery scores, length of stay, and complications. A robust cost analysis was also performed. Results The mean (range) duration of anaesthesia was 38.66 (20-60) min. Maximum and minimum intra-operative systolic blood pressure ranges were 130-210 and 75-145 mmHg, respectively (mean [range] drop, 74.13 [33-125] mmHg). Mean (range) propofol dose was 1.74 (1-3.0) mg/kg/h. The Median (interquartile range) post-operative recovery time was 30 (20-50) min. The mean (range) postoperative recovery score (local scale, range 5-28 where lower values are superior) was 5.2 (5-8). The mean (range) length of stay was 8 (1-20 days); the two included patients with ASA grade 2 were both discharged within 24 hours. One patient with predisposing history developed pneumonia; however, there were no complications related to ISB-RA. The mean (range) cost per patient was £101.36 (£59.80-£132.20). Conclusions Our data demonstrate that rTSA under ISB-RA is safe, comfortable, and cost-effective. Notably, patients with ASA grade 2 who underwent rTSA under ISB-RA had a reduced length of stay and were discharged within 24 hours. Clinical relevance rTSA under ISB-RA is potentially a safe, cost-effective, and viable alternative for patients with multiple comorbidities.

Cost Analysis of Low-Volume Versus Standard-Volume Ultrasound-Guided Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery

“…Health economic evaluation in the field of anesthesia is increasingly used for decision-making and has become a relevant component of healthcare system programs worldwide [1]. However, little is known about the economic impact of regional anesthesia [2] in general and, even less, about that of the brachial plexus block in particular [1,[3][4][5][6]. As far as the latter is concerned, the economic outcomes reported in the literature are either rather heterogeneous [1,5,6] or evaluate obsolete regional anesthesia techniques [4].…”

“…However, little is known about the economic impact of regional anesthesia [2] in general and, even less, about that of the brachial plexus block in particular [1,[3][4][5][6]. As far as the latter is concerned, the economic outcomes reported in the literature are either rather heterogeneous [1,5,6] or evaluate obsolete regional anesthesia techniques [4]. In the only randomized clinical trial assessing the economics of ultrasound-guided interscalene block in arthroscopic shoulder surgery published to date, Gonano et al concluded that interscalene block, as solo anesthesia, is a cost-effective technique as compared with general anesthesia [3].…”