Preoperative Interscalene Block for Elective Shoulder Surgery: Loss of Benefit over Early Postoperative Block After Patient Discharge to Home

Wurm, W. Heinrich; Concepción, Mercedes; Sternlicht, Andrew; Carabuena, Jean Marie; Robelen, Gary; Goudas, Leonidas C.; Strassels, Scott A.; Carr, Daniel B.

doi:10.1213/01.ane.0000090320.46129.be

Cited by 23 publications

(10 citation statements)

References 17 publications

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“…First, Wurm et al showed no differences in SF-36 outcomes at 1 and 7 days postoperatively, but this study did not describe its basis of sample size determination (interscalene block performed preoperatively versus postoperatively, n=102) 13. In a more recent study, no SF-36 differences were seen at 12 weeks postoperatively when comparing spinal anesthesia and GA for vaginal hysterectomy 14…”

Section: Discussionmentioning

confidence: 82%

General Health and Knee Function Outcomes from 7 Days to 12 Weeks After Spinal Anesthesia and Multimodal Analgesia for Anterior Cruciate Ligament Reconstruction

Williams

Dang²,

Bost³

et al. 2009

Anesthesia &Amp; Analgesia

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Background We previously reported that continuous perineural femoral analgesia reduces pain with movement during the first 2 days after anterior cruciate ligament reconstruction (ACLR, n=270), when compared with multimodal analgesia and placebo perineural femoral infusion. We now report the prospectively collected general health and knee function outcomes in the 7 days to 12 weeks after surgery in these same patients. Methods At 3 points during 12 weeks after ACLR surgery, patients completed the SF-36 General Health Survey, and the Knee Outcome Survey (KOS). Generalized Estimating Equations were implemented to evaluate the association between patient-reported survey outcomes and (i) preoperative baseline survey scores, (ii) time after surgery, and (iii) 3 nerve block treatment groups. Results Two-hundred-seventeen patients’ data were complete for analysis. In univariate and multiple regression Generalized Estimating Equations models, nerve block treatment group was not associated with SF-36 and KOS scores after surgery (all with P≥0.05). The models showed that the physical component summary of the SF-36 (P < 0.0001) and the KOS total score (P < 0.0001) increased (improved) over time after surgery and were also influenced by baseline scores. Conclusions After spinal anesthesia and multimodal analgesia for ACLR, the nerve block treatment group did not predict SF-36 or knee function outcomes from 7 days to 12 weeks after surgery. Further research is needed to determine whether these conclusions also apply to a nonstandardized anesthetic, or one that includes general anesthesia and/or high-dose opioid analgesia.

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Section: Discussionmentioning

confidence: 82%

General Health and Knee Function Outcomes from 7 Days to 12 Weeks After Spinal Anesthesia and Multimodal Analgesia for Anterior Cruciate Ligament Reconstruction

Williams

Dang²,

Bost³

et al. 2009

Anesthesia &Amp; Analgesia

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“…Rebound pain as well as incomplete effects, such as partial block or failure of the nerve block, have been reported to occur. 1,2,7,28 Furthermore, most patients who receive rotator cuff surgery are older, so we should consider the safety of the interscalene block in this age group with pulmonary comorbidity. All the successful interscalene blocks could affect the phrenic nerve, and this might lead to respiratory distress or diaphragmatic paresis.…”

Section: Discussionmentioning

confidence: 99%

An anatomic and clinical study of the suprascapular and axillary nerve blocks for shoulder arthroscopy

Nam

Jeong

Han

et al. 2011

Journal of Shoulder and Elbow Surgery

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“…However, this technique has been associated with potential side effects and complications, such as rebound pain, phrenic nerve palsy respiratory distress, or diaphragmatic paresis. [12][13][14] The combination of SSNB and ANB has been also used effectively for anesthesia in shoulder arthroscopy and these blocks have provided safe analgesia in intraoperative and early postoperative periods. 6 The philosophy of regional nerve blocks is that the local anesthetic should be infiltrated close to the nerve to the maximum extent.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of analgesics in patients undergoing arthroscopic repair of rotator cuff at Gujarat Adani institute of medical science, Bhuj, Kutch, Gujarat

Kotak¹,

Rudani²

2017

Int J Res Orthop

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Background: To evaluate analgesic efficacy when catheters are positioned with assistance of arthroscope to block suprascapular and axillary nerves in patients undergoing arthroscopic repair of rotator cuff under general anesthesia.Methods: Present study was performed at department of orthopedics, Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat. 24 patients who experienced arthroscopic repair of rotator cuff between July 2015 and October 2015 were catheterized to block suprascapular and axillary nerves through shoulder arthroscopy were incorporated in the study. Clinical outcomes were assessed using visual analog scale (VAS) scores preoperatively and at 0 h, 6 h, 12 h, 18 h, 24 h, and postoperative day 2.Results: Preoperative and postoperative 0 h, 6 h, 12 h, 18 h, 24 h, and day 2 mean VAS scores were 6.37±0.91, 0.45±0.39, 0.59±0.40, 0.62±0.39, 0.61±0.42, 0.51±0.35, and 1.54±0.50, respectively. No statistical difference was found among 0 h, 6 h, 12 h, 18 h, and 24 h time points; however, assessment of postoperative day 2 and postoperative 0 h, 6 h, 12 h, 18h and 24 h VAS scores showed statistically significant difference (P <0.05). All patients were discharged at the end of 24 h with no complication. The mean time (in minutes) required for blocking suprascapular nerve and axillar nerve were 14.38±3.21 and 3.75±0.85, respectively. Conclusions: These results confirmed that blocking two nerves with arthroscopic approach was an excellent pain management method in postoperative period. Accordingly, patients could recover rapidly and patients’ satisfaction could be improved.

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Preoperative Interscalene Block for Elective Shoulder Surgery: Loss of Benefit over Early Postoperative Block After Patient Discharge to Home

Abstract: Preoperative interscalene block with levobupivacaine provides safe and effective analgesia for same-day elective shoulder surgery, but the benefit of this one-time intervention does not persist.

Cited by 23 publications

References 17 publications

General Health and Knee Function Outcomes from 7 Days to 12 Weeks After Spinal Anesthesia and Multimodal Analgesia for Anterior Cruciate Ligament Reconstruction

General Health and Knee Function Outcomes from 7 Days to 12 Weeks After Spinal Anesthesia and Multimodal Analgesia for Anterior Cruciate Ligament Reconstruction

An anatomic and clinical study of the suprascapular and axillary nerve blocks for shoulder arthroscopy

Efficacy of analgesics in patients undergoing arthroscopic repair of rotator cuff at Gujarat Adani institute of medical science, Bhuj, Kutch, Gujarat

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