Efficacy of local infiltration anesthesia versus interscalene nerve blockade for total shoulder arthroplasty

Updegrove, Gary F.; Stauch, Chris; Ponnuru, Padmavathi; Kunselman, Allen R.; Armstrong, April D.

doi:10.1016/j.jseint.2019.12.007

Cited by 13 publications

(7 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One meta-analysis showed modest difference between local infiltration analgesia and peripheral nerve blocks in analgesia quality and opioid consumption 24 h after total hip arthroplasty, and the authors suggested that the cost and side effects of these techniques need further analysis [246]. Periarticular injection of LAs (bupivacaine) provided analgesia quality similar to peripheral nerve blocks for shoulder surgery with significant opioid-sparing effect and reduced side effects [247]. Liposomal bupivacaine is also used for foot and ankle surgery [232].…”

Section: Orthopedic Surgerymentioning

confidence: 99%

Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review

Stamenković

Bezmarević

Bojić

et al. 2021

JCM

View full text Add to dashboard Cite

Local anesthetic wound infiltration (WI) provides anesthesia for minor surgical procedures and improves postoperative analgesia as part of multimodal analgesia after general or regional anesthesia. Although pre-incisional block is preferable, in practice WI is usually done at the end of surgery. WI performed as a continuous modality reduces analgesics, prolongs the duration of analgesia, and enhances the patient’s mobilization in some cases. WI benefits are documented in open abdominal surgeries (Caesarean section, colorectal surgery, abdominal hysterectomy, herniorrhaphy), laparoscopic cholecystectomy, oncological breast surgeries, laminectomy, hallux valgus surgery, and radical prostatectomy. Surgical site infiltration requires knowledge of anatomy and the pain origin for a procedure, systematic extensive infiltration of local anesthetic in various tissue planes under direct visualization before wound closure or subcutaneously along the incision. Because the incidence of local anesthetic systemic toxicity is 11% after subcutaneous WI, appropriate local anesthetic dosing is crucial. The risk of wound infection is related to the infection incidence after each particular surgery. For WI to fully meet patient and physician expectations, mastery of the technique, patient education, appropriate local anesthetic dosing and management of the surgical wound with “aseptic, non-touch” technique are needed.

show abstract

Section: Orthopedic Surgerymentioning

confidence: 99%

Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review

Stamenković

Bezmarević

Bojić

et al. 2021

JCM

View full text Add to dashboard Cite

show abstract

“…The current body of literature on this topic is limited, with few available studies focusing on short-term clinical outcomes. They usually take into consideration only the costs associated with the immediate perioperative period, such as the anesthesiologist's salary [ 6 ] or the price of anesthetic drugs [ 1 ] and equipment [ 8 ], instead of considering long-term economic implications. On the other hand, the societal perspective considers broader costs to society, including both direct and indirect costs such as days of sick leave, as a proxy for productivity losses, which could represent up to 30% of costs [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Nowadays, the challenge faced by healthcare systems worldwide is to provide enhanced medical care in an efficient way. 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].…”

Section: Introductionmentioning

confidence: 99%

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

Oliver-Fornies,

Sánchez-Viñas,

Gomez Gomez

et al. 2023

Cureus

View full text Add to dashboard Cite

Background Economic evaluation has become an essential decision-making tool for health systems worldwide. This study was aimed at estimating the difference in the use of healthcare resources, days on sick leave, and costs between patients undergoing a standard-volume versus a low-volume ultrasound-guided interscalene brachial plexus block. Methods This is a post-hoc cost analysis of a double-blind, randomized, and controlled clinical trial. Forty-eight patients undergoing ultrasound-guided interscalene block received either 10 ml or 20 ml of levobupivacaine 0.25%. Analyses involved the public healthcare payer perspective (including visits to general practitioners, nursing staff, physiotherapy facilities, hospital admissions, outpatient diagnostic tests, etc.) and the limited societal perspective, including productivity losses (days on sick leave). Measurements were made at one-month and one-year follow-ups post-intervention. Differences in costs were estimated using two-part models adjusted by the costs incurred in the previous year. Results Subjects in the 10 ml group made greater use of general practitioner visits (mean difference [95% CI]: 3.35 [0.219 to 6.49]; p=0.036) and diagnostic tests (2.43 [0.601 to 4.26]; p=0.009), but less use of physical therapy (−12.9 [−21.7 to −4.06]; p=0.004). Mean (SD) cost differences from the public healthcare payer’s perspective were 1,461.34 $ (1,541.62) and 1,024.08$ (943.83) for the 10 ml and 20 ml groups, respectively (p=0.293). From the limited societal perspective, the differences were as follows: 7,036.53$ (8,077.58) and 8,666.56$ (9,841.10), respectively (p=0.937). While there were no differences in the above parameters at the one-month follow-up. Conclusion The volume reduction proposed following interscalene block resulted in meaningful, albeit not statistically significant, clinical benefits and lower costs from a limited societal perspective for shoulder surgery. Thus, healthcare use and days on sick leave are variables to be taken into consideration when calculating the economic impact of surgical procedures.

show abstract

“…36 Our pathway also recommends the use of intra-operative infiltration of local anaesthetic after studies have shown to be an effective analgesic in shoulder arthroplasty. 37 We also recommend 1 g of intravenous tranexamic acid at induction (unless contra-indicated) after studies have been shown to reduce blood loss, pain and haematoma formation. 38 Post-operative Phase: Our post-operative discharge medication pack was extrapolated from the Guidelines for Day-Case Surgery from the Association of Anaesthetists.…”

Section: Resultsmentioning

confidence: 99%

Introducing A Day-Case Shoulder Arthroplasty Pathway In The UK – How We Did It

et al. 2022

View full text Add to dashboard Cite

Background As the demand for elective orthopaedics grows, day-case arthroplasty is gaining popularity. The aim of this study was to create a safe and reproducible pathway for day-case shoulder arthroplasty (DCSA) based upon a literature review and discussion with the local multidisciplinary team (MDT). Methods A literature review was performed using OVID MEDLINE and Embase databases reporting 90-day complication and admission rates following DCSA. Minimum follow-up was 30 days. Day-case was defined as discharge on the same day of surgery. Results The literature review revealed a mean 90-day complication rate of 7.7% [range, 0–15.9%] and mean 90-day readmission rate of 2.5% [range 0−9.3%]. A pilot protocol was devised based upon the literature review and consisted of 5 phases: (1) pre-operative assessment, (2) intra-operative phase, (3) post-operative phase, (4) follow-up, and (5) readmission protocol. This was presented, discussed, amended, and ultimately ratified by the local MDT. In May 2021 the unit successfully completed its first day-case shoulder arthroplasty. Discussion This study proposes a safe and reproducible pathway for DCSA. Patient selection, well-defined protocols and communication within the MDT are important factors to achieve this. Further studies with extended follow-up will be needed to gauge long-term success within our unit.

show abstract

Efficacy of local infiltration anesthesia versus interscalene nerve blockade for total shoulder arthroplasty

Cited by 13 publications

References 30 publications

Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review

Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review

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

Introducing A Day-Case Shoulder Arthroplasty Pathway In The UK – How We Did It

Contact Info

Product

Resources

About