Interscalene brachial plexus block for outpatient shoulder arthroplasty: Postoperative analgesia, patient satisfaction and complications

Abstract

Background:Shoulder arthroplasty procedures are seldom performed on an ambulatory basis. Our objective was to examine postoperative analgesia, nausea and vomiting, patient satisfaction and complications of ambulatory shoulder arthroplasty performed using interscalene brachial plexus block (ISB).Materials and Methods:We prospectively examined 82 consecutive patients undergoing total and hemi-shoulder arthroplasty under ISB. Eighty-nine per cent (n=73) of patients received a continuous ISB; 11% (n=9) received a single-injection ISB. The blocks were performed using a nerve stimulator technique. Thirty to 40 mL of 0.5% ropivacaine with 1:400,000 epinephrine was injected perineurally after appropriate muscle twitches were elicited at a current of less than 0.5% mA. Data were collected in the preoperative holding area, intraoperatively and postoperatively including the postanesthesia care unit (PACU), at 24h and at seven days.Results:Mean postoperative pain scores at rest were 0.8 ± 2.3 in PACU (with movement, 0.9 ± 2.5), 2.5 ± 3.1 at 24h and 2.8 ± 2.1 at seven days. Mean postoperative nausea and vomiting (PONV) scores were 0.2 ± 1.2 in the PACU and 0.4 ± 1.4 at 24h. Satisfaction scores were 4.8 ± 0.6 and 4.8 ± 0.7, respectively, at 24h and seven days. Minimal complications were noted postoperatively at 30 days.Conclusions:Regional anesthesia offers sufficient analgesia during the hospital stay for shoulder arthroplasty procedures while adhering to high patient comfort and satisfaction, with low complications.

Peripheral Nerve Blocks in Shoulder Arthroplasty: How Do They Influence Complications and Length of Stay?

“…Results from smaller, single-institutional trials are largely in accordance with our findings of low complication rates [5,27,30]. Peripheral nerve blocks predominantly used for shoulder surgery include the interscalene and supraclavicular plexus blocks, both providing good analgesic coverage of the proximal upper extremity, along with a high rate of block success [13].…”

“…Numerous stringent integrity checks by the vendor lead to a generally high level of reliability in the database, as evidenced in numerous prior publications [19,22,25]. Described advantages of regional anesthesia for shoulder surgery include improved analgesia [27], lower intraoperative blood loss [31], better postoperative ROM of the replaced joint [15], and earlier discharge readiness [14]. The percentage of patients receiving an upper-extremity nerve block in addition to general anesthesia for total shoulder arthroplasty was about 20%.…”

“…Upper-extremity peripheral nerve block techniques frequently are utilized in combination with general anesthesia as a strategy to reduce requirement for systemic analgesics, facilitate rehabilitation, and potentially allow for earlier discharge after total shoulder arthroplasty [5,27,31]. However, concerns have been raised in the past regarding the safety of upperextremity nerve blocks, owing to the occurrence of perioperative respiratory and neurologic complications [26,30,34,35].…”

Epidemiology, trends, and disparities in regional anaesthesia for orthopaedic surgery

“…9 38 40-42 In shoulder arthroplasty, evidence has suggested that PNBs added to GA are highly effective for anaesthesia and analgesia and can significantly reduce the need for systemic analgesics while facilitating improved rehabilitation and earlier discharge. [58][59][60] Stundner and colleagues 41 studied use of PNBs in 17 157 total shoulder arthroplasty patients using data from Premier Perspective Inc. Peripheral nerve blocks were administered in 21% of the patients between 2007 and 2011; analysis did not reveal any difference in complication risk but a trend towards shorter length of stay.…”

Do liposomal bupivacaine infiltration and interscalene nerve block provide similar pain relief after total shoulder arthroplasty: a systematic review and meta-analysis

“…Interscalene nerve block (INB) can provide reliable analgesic coverage for the entire field of surgery and has been recognized as an effective regional technique for pain control in patients undergoing TSA. 6 Compared with general anesthesia, INB is correlated with reduced pain, decreased opioid consumption, better sleep quality, shorter hospital stay, and increased patient satisfaction. 7 , 8 However, concerns remain about the 10%–20% failure rate of nerve blockade and the possibility of neurologic or respiratory complications stemming from INB.…”