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      A Comparison of Three Methods for Postoperative Pain Control in Patients Undergoing Arthroscopic Shoulder Surgery

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          Abstract

          Background

          Arthroscopic shoulder operations (ASS) are often associated with severe postoperative pain. Nerve blocks have been studied for pain in shoulder surgeries. Interscalene brachial plexus blocks (ISB) and an intra-articular injection (IA) have been reported in many studies. The aim of the present study is to evaluate the effect of ISB, a continuous cervical epidural block (CCE) and IA as a means of postoperative pain control and to study the influence of these procedures on postoperative analgesic consumption and after ASS.

          Methods

          Fifty seven patients who underwent ASS under general anesthesia were randomly assigned to one of three groups: the ISB group (n = 19), the CCE group (n = 19), and the IA group (n = 19). Patients in each group were evaluated on a postoperative numerical rating scale (NRS), their rescue opioid dosage (ROD), and side effects.

          Results

          Postoperative NRSs were found to be higher in the IA group than in the ISB and CCE groups both at rest and on movement. The ROD were 1.6 ± 2.3, 3.0 ± 4.9 and 7.1 ± 7.9 mg morphine equivalent dose in groups CCE, ISB, and IA groups ( P = 0.001), respectively, and statistically significant differences were noted between the CCE and IA groups ( P = 0.01) but not in between the ISB and CCE groups.

          Conclusions

          This prospective, randomized study demonstrated that ISB is as effective analgesic technique as a CCE for postoperative pain control in patients undergoing ASS.

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          Most cited references28

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          A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy--a systematic review and meta-analysis of randomized trials.

          G. Davies, P. MYLES, Simon J. Graham (2006)
          Epidural analgesia is considered by many to be the best method of pain relief after major surgery. It is used routinely in many thoracic surgery centres. Although effective, side-effects include hypotension, urinary retention, incomplete (or failed) block, and, in rare cases, paraplegia. Paravertebral block (PVB) is an alternative technique that may offer comparable analgesic effectiveness and a better side-effect profile. We undertook a systematic review and meta-analysis of all relevant randomized trials comparing PVB with epidural analgesia in thoracic surgery. Data were abstracted and verified by both authors. Studies were tested for heterogeneity, and meta-analyses were done with random effects or fixed effects models. Weighted mean difference (WMD) was used for numerical outcomes and odds ratio (OR) for dichotomous outcomes, both with 95% CI. We identified 10 trials that had enrolled 520 thoracic surgery patients. All of the trials were small (n<130) and none were blinded. There was no significant difference between PVB and epidural groups for pain scores at 4-8, 24 or 48 h, WMD 0.37 (95% CI: -0.5, 121), 0.05 (-0.6, 0.7), -0.04 (-0.4, 0.3), respectively. Pulmonary complications occurred less often with PVB, OR 0.36 (0.14, 0.92). Urinary retention, OR 0.23 (0.10, 0.51), nausea and vomiting, OR 0.47 (0.24, 0.53), and hypotension, OR 0.23 (0.11, 0.48), were less common with PVB. Rates of failed block were lower in the PVB group, OR 0.28 (0.2, 0.6). PVB and epidural analgesia provide comparable pain relief after thoracic surgery, but PVB has a better side-effect profile and is associated with a reduction in pulmonary complications. PVB can be recommended for major thoracic surgery.
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            Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials.

            J. Richman, Richard Thirlby, Stephanie S. Liu … (2006)
            Article 0 comments Cited 76 times – based on 0 reviews     Review now
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              Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques.

              Michael J Fredrickson, S. Krishnan, Julie Y. Chen (2010)
              Shoulder surgery is well recognised as having the potential to cause severe postoperative pain. The aim of this review is to assess critically the evidence relating to the effectiveness of regional anaesthesia techniques commonly used for postoperative analgesia following shoulder surgery. Subacromial/intra-articular local anaesthetic infiltration appears to perform only marginally better than placebo, and because the technique has been associated with catastrophic chondrolysis, it can no longer be recommended. All single injection nerve blocks are limited by a short effective duration. Suprascapular nerve block reduces postoperative pain and opioid consumption following arthroscopic surgery, but provides inferior analgesia compared with single injection interscalene block. Continuous interscalene block incorporating a basal local anaesthetic infusion and patient controlled boluses is the most effective analgesic technique following both major and minor shoulder surgery. However, interscalene nerve block is an invasive procedure with potentially serious complications and should therefore only be performed by practitioners with appropriate experience.
              Article 0 comments Cited 75 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Pain
                Journal ID (iso-abbrev): Korean J Pain
                Journal ID (publisher-id): KJP
                Title: The Korean Journal of Pain
                Publisher: The Korean Pain Society
                ISSN (Print): 2005-9159
                ISSN (Electronic): 2093-0569
                Publication date (Print): January 2015
                Publication date (Electronic): 02 January 2015
                Volume: 28
                Issue: 1
                Pages: 45-51
                Affiliations
                Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju, Korea.
                [* ]Department of Orthopedic Surgery, Jeju National University Hospital, Jeju, Korea.
                [† ]Department of Emergency Medicine, Jeju National University Hospital, Jeju, Korea.
                Author notes
                Correspondence to: Yun Suk Choi. Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju 690-767, Korea. Tel: +82-64-717-2025, Fax: +82-64-717-2042, solafide5@ 123456yahoo.co.kr
                Article
                DOI: 10.3344/kjp.2015.28.1.45
                PMC ID: 4293507
                PubMed ID: 25589946
                SO-VID: 1e4a14e7-e4b4-4dc8-b518-1a3b39e292d1
                Copyright © Copyright © The Korean Pain Society, 2015
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 11 September 2014
                Date revision received : 08 December 2014
                Date accepted : 08 December 2014
                Funding
                Funded by: Jeju National University Hospital
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: analgesia,arthroscopy,epidural anesthesia,interscalene block,intraarticular injection,pain
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: analgesia, arthroscopy, epidural anesthesia, interscalene block, intraarticular injection, pain

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