Single shot interscalene regional anesthesia provides noninferior analgesia and decreased complications compared with an indwelling catheter for arthroscopic and reconstructive shoulder surgery

Teske, Lucas; Pill, Stephan G.; Lutz, Adam; Thigpen, Charles A.; Shanley, Ellen; Adams, Kyle; Bohon, Hunter; Graham, George D; Marston, Geoffrey; Walker, Kevin B.; Kissenberth, Michael J.

doi:10.1016/j.jse.2022.02.004

Cited by 3 publications

(2 citation statements)

References 13 publications

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“…Retrospective comparison of peripheral catheters to single-injection nerve blockade for shoulder surgery found similar pain scores in both groups. However, complications were five-times more likely with the continuous blocks (2% vs. 10%, all pulmonary-related) [15 ▪ ]. Given that many centers have success with perineural catheters, these findings would need prospective replication.…”

Section: Analgesic Pathway Componentsmentioning

confidence: 94%

Clinical care pathways for ambulatory total shoulder arthroplasty

Dong

YaDeau

2022

Current Opinion in Anaesthesiology

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Purpose of reviewTotal shoulder arthroplasty (TSA) is growing in popularity and is increasingly done on an ambulatory basis. This review examines recent developments in anesthesia and analgesia for ambulatory shoulder surgery. Pathway components are discussed and a sample pathway is described. Recent FindingsAdoption of pathways for shoulder surgery improves patient experience by reducing pain, opioid use, and side effects while improving patient satisfaction. Long-acting nerve blockade using adjuvants like dexamethasone provide long-lasting analgesia without rebound pain. Peripheral nerve blockade provides better analgesia than peri-articular injection of local anesthetic. There are multiple approaches to nerve blockade for shoulder surgery to consider, including interscalene, superior trunk, supraclavicular, and anterior suprascapular nerve blocks. Multimodal analgesia should include acetaminophen and nonsteroidal anti-inflammatory drugs, but routine gabapentinoids should not be used.

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Section: Analgesic Pathway Componentsmentioning

confidence: 94%

Clinical care pathways for ambulatory total shoulder arthroplasty

Dong

YaDeau

2022

Current Opinion in Anaesthesiology

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“…(7) Unfortunately, CC PNB is more challenging to perform, more costly, and consumes more resources in the immediate post-operative period than SS PNB. (1,8,9) Many studies have demonstrated that patient education can improve patient outcomes, including pain and anxiety. (10)(11)(12) We hypothesized that a multimedia education program made available to patients including videos, handouts, and bedside teaching, for both SS PNB and CC PNB, would improve patient knowledge and understanding of PNBs as well as what to expect in the postoperative period and decrease unplanned, PNB-related postoperative healthcare resource utilization.…”

mentioning

confidence: 99%

Effect of Patient Education on Postoperative Healthcare Resource Utilization and Patient Satisfaction for Patients Receiving Peripheral Nerve Blockade: A Pragmatic Prospective Study

Zuo,

Ivie,

Tully

et al. 2023

Preprint

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Background Peripheral nerve block (PNB) is associated with high satisfaction but increased postoperative healthcare resource utilization, perhaps due to inadequate communication of expected PNB behavior to patients. We hypothesized pragmatic multimedia education for patients undergoing PNB would decrease unplanned, postoperative PNB-related healthcare resource utilization. Methods This single-center, prospective, before-after, non-randomized study enrolled 600 ambulatory orthopedic surgery patients receiving PNB. In this original research Group 1 (n = 300) received standard education and Group 2 (n = 300) received multimedia education including handouts and videos. The primary outcome was unplanned, PNB-related postoperative healthcare resource utilization (unplanned visit to physician's office or emergency department, or unplanned phone call, relating to pain or problems with the PNB); secondary outcomes included knowledge of PNB. Data analysis used two-sample t-test, Pearson’s chi-square test, or Fisher’s exact test. Results We enrolled 300 patients in each group (N = 600). Follow-up response rates were 76% (Group 1, n = 229) and 82% (Group 2, n = 246). Our main findings indicate there was no significant difference in seeking unplanned PNB-related care in the first 4 days after surgery between Group 1 and Group 2 (14.4% vs 15.5%, respectively, p = 0.75). There was no difference in satisfaction with postoperative pain management and PNB information received between groups (p = 0.37). 90.4% (N = 207/229) in Group 1 and 87.8% (N = 216/246) in Group 2 were satisfied or very satisfied with post op pain management. Mean knowledge test scores were 7.8 (± 1.9) in Group 1 and 8.7 (± 1.3) in Group 2 (p < 0.0001; n = 149 in Group 1 and n = 115 in Group 2). Conclusions Pragmatic multimedia education for PNB did not change rates of unplanned, postoperative PNB-related healthcare resource utilization or satisfaction, although it improved patient knowledge. Further research will be necessary to investigate if the benefits of comprehensive multimedia education provided in the days prior to surgery will outweigh the costs of decreased production throughput and increased resource input in coordination of this patient education program.

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