Comparison of continuous interscalene block and subacromial infusion of local anesthetic for postoperative analgesia after open shoulder surgery

Abstract

Purpose: This study compared the efficacy of continuous interscalene block (CISB) and subacromial infusion of local anesthetic (CSIA) for postoperative analgesia after open shoulder surgery. Methods: This randomized, prospective, double-blinded, single-center study included 40 adult patients undergoing open shoulder surgery. All patients received a standardized general anesthetic. The patients were separated into group CISB and group CSIA. A loading dose of 40 mL 0.25% bupivacaine was administered and patient-controlled analgesia was applied by catheter with 0.1% bupivacaine 5 mL/h throughout 24 h basal infusion, 2 mL bolus dose, and 20 min knocked time in both groups postoperatively. Visual analog scale (VAS) scores, additional analgesia need, local anesthetic consumption, complications, and side effects were recorded during the first 24 h postoperatively. The range of motion (ROM) score was recorded preoperatively and in the first and third weeks postoperatively. Results: A statistically significant difference was determined between the groups in respect of consumption of local anesthetic, VAS scores, additional analgesia consumption, complications, and side effects, with lower values recorded in the CISB group. There were no significant differences in ROM scoring in the preoperative and postoperative third week between the two groups but there were significant differences in ROM scoring in the postoperative first week, with higher ROM scoring values in the group CISB patients. Conclusion: The results of this study have shown that continuous interscalene infusion of bupivacaine is an effective and safe method of postoperative analgesia after open shoulder surgery.

Comparison of local infiltration analgesia and interscalene block for postoperative pain management in shoulder arthroscopy: a prospective randomized controlled trial

“…Local infiltration analgesia is a simple, safe, and effective analgesic technique [14]. In the literature, there are many studies about local infiltration analgesia injection into the shoulder joint [3,8,9,15,16]. However, no studies have been found in the literature regarding the use of Ranawat cocktail in the shoulder joint.…”

“…Laurila et al reported that IBPB effectively reduced early postoperative pain and opioid need compared to subacromial bursa block after shoulder arthroscopy [3]. Baskan et al noted that continuous interscalene block reduces postoperative pain more safely and effectively in the open shoulder surgery [8]. Souvatzoglou et al reported that continuous interscalene nerve blockade was a better postoperative analgesia control compared to continuous subacromial administration of ropivacaine in shoulder surgery [9].…”

“…A 21G needle (Techniplex, 50 mm, 30°; Vygon, Ecouen, France) was advanced until it was inserted between the C5 and C6 nerve trunks. After careful aspiration to prevent intravascular injection, the block was applied with 20 mL 0.5% bupivacaine [8].…”

“…Interscalene brachial plexus block (IBPB) has been reported to provide effective analgesia [6,7]. The content of a local infiltration anesthetic, which is reported to be as effective as an interscalene block in shoulder arthroscopy, has not been disclosed to the best of our knowledge [3,8,9]. Ranawat cocktail is one of the local infiltration analgesia methods used for effective postoperative pain management in knee and hip surgery [10,11].…”