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

Abstract

Background Regional anesthesia has proven to be a highly effective technique for pain control after total shoulder arthroplasty. However, concerns have been raised about the safety of upper-extremity nerve blocks, particularly with respect to the incidence of perioperative respiratory and neurologic complications, and little is known about their influence, if any, on length of stay after surgery. Questions/purposes Using a large national cohort, we asked: (1) How frequently are upper-extremity peripheral nerve blocks added to general anesthesia in patients undergoing total shoulder arthroplasty? (2) Are there differences in the incidence of and adjusted risk for major perioperative complications and mortality between patients receiving general anesthesia with and without nerve blocks? And (3) does resource utilization (blood product transfusion, intensive care unit admission, length of stay) differ between groups? Methods We searched a nationwide discharge database for patients undergoing total shoulder arthroplasty under general anesthesia with or without addition of a nerve Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. The institution of one of the authors (SGM) has received, during the study, funding from the Anna-Maria and Stephen Kellen Physician-Scientist Career Development Award provided by the Hospital for Special Surgery. One or more of the authors (RR, YLC, XS, MM) has received, during the study,

Regional anesthesia decreases complications and resource utilization in shoulder arthroplasty patients

“…Prior research from years 2007-11, also using similar administrative data, found that 21% of patients had a nerve block for total shoulder arthroplasty surgery. 8 Despite the growth in ultrasound-guided regional anesthesia and the national emphasis on opioid reduction strategies, our data confirm the persistent low utilization (20.9%) of regional anesthesia techniques. Given that our data comes from a large cohort of hospitals and health systems…”

Pain and Opioid Use After Total Shoulder Arthroplasty With Injectable Liposomal Bupivacaine Versus Interscalene Block

“…Interscalene brachial plexus block is arguably the gold standard for adjunctive analgesia for total shoulder arthroplasty. 12,36 Gohl et al 13 reported a pain control regimen that included interscalene block in patients undergoing open shoulder procedures. Their study found that patients who received interscalene block in addition to general anesthesia had lower postoperative pain scores compared with those who did not receive an adjunctive block.…”

Ultrasound guidance for peripheral nerve blocks: an observational trend study of national data

“…Cohorts were defined based on international classification of diseases, ninth revision (ICD-9) procedure codes for shoulder, total hip, and total knee arthroplasty procedures from 2006 through 2016. Regional anesthesia procedures were defined using Current Procedural Terminology (CPT) codes and ICD-9 codes as previously described 2 3. Associated ultrasound use was identified through billing charges, CPT codes (20604, 20606, 20611, 93355, 76930, 76932, 76936, 76937, 76940, 76941, 76942, 76945, 76946, 76948, 76965, 76998) or ICD-9 procedure codes (88.7, 00.2, 38.97).…”