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

Abstract

SummaryContinuous interscalene brachial plexus block has been shown to be the most effective analgesic technique following shoulder surgery; however, its use is uncommon due to logistical and safety concerns related to ambulatory administration. We prospectively studied 1505 consecutive patients undergoing shoulder surgery who received continuous interscalene analgesia at home. Catheter removal was by the patient between postoperative days two and five. There were no major complications although 27% of patients reported mild dyspnoea, 13% hoarseness and 7% dysphagia. Twelve percent sought medical advice and 2% reported technical issues with the pump or tubing. Complications and technical issues were associated with patient age; weight; use of ultrasound or concomitant nerve stimulation as the endpoint for final needle tip position; local anaesthetic placement via the catheter or needle; whether a catheterrelated intervention for pain relief was required in the recovery area; and the type of ambulatory pump. We conclude that this study supports the safety of this underused analgesic technique.

Promoting the use of peripheral nerve catheters: better catheter accuracy or more user‐friendliness?

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Single-injection interscalene bupivacaine and dexamethasone for same-day discharge total shoulder arthroplasty: a case series

“…1 Ambulatory infusion pumps, however, require additional resources, and nerve plexus catheters are associated with complications. 2 In October 2011, our health region launched a same-day discharge TSA program at a freestanding, publicly funded surgical centre. For postoperative analgesia, the program employed ultrasound-guided SISB with 8 mg perineural preservative-free dexamethasone sodium phosphate (Dexamethasone Omega Unidose 10 mgÁmL -1 , Omega Laboratories Limited, Montreal, QC, Canada) 3 and 0.5% bupivacaine with 1:200,000 epinephrine (0.4 mLÁkg -1 maximum 40 mL).…”

Interscalene catheters for shoulder surgery - a reply

“…Subjects were only discharged home if they demonstrated satisfactory oxygen saturation on air. Although we do not have data regarding home oxygen saturation, no patient developed a complication related to hypoxia, as this would have been detected with our rigorous follow‐up protocol .…”