Subacromial analgesia via continuous infusion catheter vs. placebo following arthroscopic shoulder surgery: a systematic review and meta-analysis of randomized trials

An, Vincent V.G.; Farey, John; Karunaratne, Sascha; Smithers, Christopher J.; Petchell, Jeffrey

doi:10.1016/j.jse.2019.11.010

Cited by 8 publications

(4 citation statements)

References 34 publications

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“…In the literature, subacromial block is reported to have a lower complication rate than interscalene block [21]. However, in one study, local anesthetic drug infusion through a subacromial catheter did not show a clinically significant benefit compared with placebo in shoulder arthroscopy cases and was not cost effective despite low complication rates [22].…”

Section: Discussionmentioning

confidence: 96%

Evaluation of our patient-controlled analgesia protocols applied in orthopedi̇c surgery

Sarikaya,

Gucyetmez,

Yildirim

et al. 2024

Med-Science

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The patient-controlled analgesia (PCA) method is a crucial part of daily anesthesia practice, with different application methods to provide analgesia after orthopedic surgeries. This study aims to assess the effectiveness of intravenous (IV), interscalene, and subacromial PCA in managing postoperative pain in shoulder arthroscopy operations performed at our clinic. Follow-up forms of patients aged between 25 and 85 who were operated on and underwent PCA in the Istanbul Medical Faculty Orthopedics operating room were scanned. The patients who underwent shoulder arthroscopy were divided into three main groups (intravenous, interscalene, and subacromial) according to the PCA application method. Visual Analog Scale (VAS) values at rest and during movement, the presence of nausea and vomiting, and the need for additional analgesia were recorded. Of the 142 patients in whom PCA was used after shoulder arthroscopy, 40 had intravenous, 41 had interscalene, and 61 had subacromial PCA. The demographic characteristics (age, gender, and body mass index) of all three groups were statistically similar. When we look at the percentage of cases with a resting VAS value >3 in patients who underwent intravenous, interscalene, and subacromial PCA, it was found to be 25%, 0.0%, and 32.8%, respectively (p=0.005). The percentage of cases with a movement VAS value >3 was 80%, 12.2%, and 73.8% for the groups, respectively (p<0.001). Additional analgesia was required in 80% of intravenous PCA patients, 52.5% of subacromial PCA patients, and 7.3% of interscalene PCA patients (p<0.001). Vomiting complaints occurred in 50%, 2.4%, and 1.6% of intravenous, interscalene, and subacromial PCA, respectively (p<0.001). Using interscalene PCA instead of intravenous PCA significantly reduced the likelihood of a VAS score at movement of more than 3 and the need for additional analgesic administration (p<0.001). Postoperative pain control after arthroscopic shoulder surgery is important for the patient's comfort and recovery. Patient-controlled analgesia can be applied intravenously, subacromial, or interscalene to control postoperative pain in this patient group. However, interscalene PCA application is a more effective method than intravenous application in terms of both pain control and side effects.

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Section: Discussionmentioning

confidence: 96%

Evaluation of our patient-controlled analgesia protocols applied in orthopedi̇c surgery

Sarikaya,

Gucyetmez,

Yildirim

et al. 2024

Med-Science

View full text Add to dashboard Cite

show abstract

“…Studies have proposed injecting local anesthetics into the subacromial space or intra-articularly, with or without the use of an indwelling catheter. The results demonstrated minimal benefit in reducing postoperative pain [59][60][61][62] . There seems to be a trend of arthroscopic procedures showing more benefit from continuous injection into the subacromial space via an indwelling catheter with respect to decreasing postoperative pain compared with open procedures 61,[63][64][65] .…”

Section: Periarticular Injections Subacromial or Intra-articular Inje...mentioning

confidence: 89%

Perioperative Pain Management in Ambulatory and Inpatient Shoulder Surgery

et al. 2021

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Acetaminophen is an effective addition to a multimodal pain regimen; however, evidence to support intravenous versus oral administration requires further evaluation.While nonsteroidal anti-inflammatory drugs are a valuable addition to a multimodal pain strategy, concerns regarding their effect on healing after certain procedures (i.e., rotator cuff repair) in select patients may preclude their use.The use of perioperative gabapentinoids have varied results for pain control, and additional research is warranted to support their use after certain shoulder procedures.Opioid-prescribing should be limited and reserved for severe postoperative pain. When prescribed, opioids should be taken at the lowest possible dose and for the shortest period.Centrally acting analgesics such as tramadol have been shown to be as effective as opioids and have a lower risk of complications.Nerve blocks are an excellent addition to multimodal pain management strategies. Longer-lasting formulations of perioperative single-shot injections and indwelling catheters may reduce rebound pain.

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“…There were 8 RCTs comparing continuous subacromial infusion with a placebo. All of these studies were included in a recent meta-analysis by An et al 9 Their pooled analysis revealed no clinically significant difference in pain scores at 6, 12, 24, or 48 hours. Additionally, they reported no significant difference in opioid consumption at 24 or 48 hours.…”

Section: Subacromial Infusionmentioning

confidence: 99%

Pain Control After Shoulder Arthroscopy: A Systematic Review of Randomized Controlled Trials With a Network Meta-analysis

et al. 2020

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Background: Shoulder arthroscopy is one of the most commonly performed orthopaedic procedures used to treat a variety of conditions, with >500,000 procedures performed each year. Purpose: To systematically review the randomized controlled trials (RCTs) on pain control after shoulder arthroscopy in the acute postoperative setting and to ascertain the best available evidence in managing pain after shoulder arthroscopy to optimize patient outcomes. Study Design: Systematic review and meta-analysis. Methods: A systematic review of the literature was performed based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. Studies were included if they were RCTs evaluating interventions to reduce postoperative pain after shoulder arthroscopy: nerve blocks, nerve block adjuncts, subacromial injections, patient-controlled analgesia, oral medications, or other modalities. Meta-analyses and network meta-analyses were performed where appropriate. Results: Our study included 83 RCTs. Across 40 studies, peripheral nerve blocks were found to significantly reduce postoperative pain and opioid use, but there was no significant difference among the variable nerve blocks in the network meta-analysis. However, continuous interscalene block did have the highest P-score at most time points. Nerve block adjuncts were consistently shown across 18 studies to prolong the nerve block time and reduce pain. Preoperative administration was shown to significantly reduce postoperative pain scores ( P < .05). No benefit was found in any of the studies evaluating subacromial infusions. Conclusion: Continuous interscalene block resulted in the lowest pain levels at most time points, although this was not significantly different when compared with the other nerve blocks. Additionally, nerve block adjuncts may prolong the postoperative block time and improve pain control. There is promising evidence for some oral medications and newer modalities to control pain and reduce opioid use. However, we found no evidence to support the use of subacromial infusions or patient-controlled analgesia.

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Subacromial analgesia via continuous infusion catheter vs. placebo following arthroscopic shoulder surgery: a systematic review and meta-analysis of randomized trials

Cited by 8 publications

References 34 publications

Evaluation of our patient-controlled analgesia protocols applied in orthopedi̇c surgery

Evaluation of our patient-controlled analgesia protocols applied in orthopedi̇c surgery

Perioperative Pain Management in Ambulatory and Inpatient Shoulder Surgery

Pain Control After Shoulder Arthroscopy: A Systematic Review of Randomized Controlled Trials With a Network Meta-analysis

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