A retrospective analysis of 509 consecutive interscalene catheter insertions for ambulatory surgery

Abstract

SummaryEffective pain therapy after shoulder surgery is the main prerequisite for safe management in an ambulatory setting. We evaluated adverse events and hospital re-admission using a database of 509 interscalene catheters inserted during ambulatory shoulder surgery. Adverse events were recorded for 34 (6.7%) patients (9 (1.8%) catheter dislocations diagnosed in the recovery room, 9 (1.8%) catheter dislocations at home with pain, 2 (0.4%) pain without catheter dislocation, 1 (0.2%) 'secondary' pneumothorax without intervention and 13 (2.6%) other). Twelve (2.4%) patients were re-admitted to hospital (8 (1.6%) for pain, 2 (0.4%) for dyspnoea and 2 (0.4%) for nausea and vomiting), 9 of whom had rotator cuff repair. A well-organised infrastructure, optimally trained medical professionals and appropriate patient selection are the main prerequisites for the safe, effective implementation of ambulatory interscalene catheters in routine clinical practice.

An analysis of 1505 consecutive patients receiving continuous interscalene analgesia at home: a multicentre prospective safety study

“…Although continuous ambulatory blocks at home have been reported for over a decade, a recent commentary questioned whether the techniques are feasible outside the setting of small, tightly controlled, clinical trials, and concerns have also been raised regarding their safety . Published evidence regarding the safety of ambulatory continuous interscalene analgesia is currently limited to small prospective randomised trials , retrospective chart reviews and a relatively small prospective audit that included 300 patients . Retrospective chart or database reviews, compared with prospective studies with predefined outcome criteria, are limited in that they are more likely to have missing data and under estimate the complication rate.…”

Perineural Low-Dose Dexamethasone Prolongs Interscalene Block Analgesia With Bupivacaine Compared With Systemic Dexamethasone

“…7 In addition, a 6.7% incidence of adverse events including inadequate analgesia, catheter dislodgement or disconnections, and pneumothorax has been recorded for interscalene catheter insertions for ambulatory surgery. 8 A single-shot ISB with a longer duration of action may offer some of the benefits of a catheter without these disadvantages.…”

Association of peripheral nerve blocks with postoperative outcomes in ambulatory shoulder surgery patients: a single-centre matched-cohort study

“…Studies have not extensively examined administration of catheters vs single shot PNBs in healthcare, but a number of case series have shown safety and efficacy of PNB catheters in the ambulatory setting. 34,35 In defining our composite outcome, we hypothesized that the known positive impact of PNBs on day-of-surgery outcomes would translate beyond hospital discharge, especially since the majority of PNBs were placed as catheters. Nevertheless, despite the lack of significant differences in primary or secondary outcomes between people with and without PNBs, the differing directional associations found warrant closer examination.…”