The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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A Comparison of Three Methods for Postoperative Pain Control in Patients Undergoing Arthroscopic Shoulder Surgery

  • Park, Sun Kyung (Department of Anesthesiology and Pain Medicine, Jeju National University Hospital) ;
  • Choi, Yun Suk (Department of Anesthesiology and Pain Medicine, Jeju National University Hospital) ;
  • Choi, Sung Wook (Department of Orthopedic Surgery, Jeju National University Hospital) ;
  • Song, Sung Wook (Department of Emergency Medicine, Jeju National University Hospital)
  • Received : 2014.09.11
  • Accepted : 2014.12.08
  • Published : 2015.01.01
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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 $1.6{\pm}2.3$, $3.0{\pm}4.9$ and $7.1{\pm}7.9$ 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.

Keywords

References

  1. Boss AP, Maurer T, Seiler S, Aeschbach A, Hintermann B, Strebel S. Continuous subacromial bupivacaine infusion for postoperative analgesia after open acromioplasty and rotator cuff repair: preliminary results. J Shoulder Elbow Surg 2004; 13: 630-4. https://doi.org/10.1016/j.jse.2004.04.005
  2. Cho CH, Song KS, Min BW, Jung GH, Lee YK, Shin HK. Efficacy of interscalene block combined with multimodal pain control for postoperative analgesia after rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2012 [in press].
  3. Fredrickson MJ, Krishnan S, Chen CY. Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques. Anaesthesia 2010; 65: 608-24. https://doi.org/10.1111/j.1365-2044.2009.06231.x
  4. Ilfeld BM, Morey TE, Wright TW, Chidgey LK, Enneking FK. Continuous interscalene brachial plexus block for postoperative pain control at home: a randomized, double-blinded, placebo-controlled study. Anesth Analg 2003; 96: 1089-95.
  5. Singelyn FJ, Lhotel L, Fabre B. Pain relief after arthroscopic shoulder surgery: a comparison of intraarticular analgesia, suprascapular nerve block, and interscalene brachial plexus block. Anesth Analg 2004; 99: 589-92.
  6. Tsui BC, Bury J, Bouliane M, Ganapathy S. Cervical epidural analgesia via a thoracic approach using nerve-stimulation guidance in adult patients undergoing total shoulder replacement surgery. Acta Anaesthesiol Scand 2007; 51: 255-60. https://doi.org/10.1111/j.1399-6576.2006.1184.x
  7. Klein SM, Nielsen KC, Martin A, White W, Warner DS, Steele SM, et al. Interscalene brachial plexus block with continuous intraarticular infusion of ropivacaine. Anesth Analg 2001; 93: 601-5. https://doi.org/10.1097/00000539-200109000-00015
  8. Beaudet V, Williams SR, Tetreault P, Perrault MA. Perioperative interscalene block versus intra-articular injection of local anesthetics for postoperative analgesia in shoulder surgery. Reg Anesth Pain Med 2008; 33: 134-8.
  9. Hughes MS, Matava MJ, Wright RW, Brophy RH, Smith MV. Interscalene brachial plexus block for arthroscopic shoulder surgery: a systematic review. J Bone Joint Surg Am 2013; 95: 1318-24. https://doi.org/10.2106/JBJS.L.01116
  10. Al-Kaisy A, McGuire G, Chan VW, Bruin G, Peng P, Miniaci A, et al. Analgesic effect of interscalene block using lowdose bupivacaine for outpatient arthroscopic shoulder surgery. Reg Anesth Pain Med 1998; 23: 469-73.
  11. Simeoforidou M, Vretzakis G, Chantzi E, Bareka M, Tsiaka K, Iatrou C, et al. Effect of interscalene brachial plexus block on heart rate variability. Korean J Anesthesiol 2013; 64: 432-8. https://doi.org/10.4097/kjae.2013.64.5.432
  12. Lee HY, Kim SH, So KY, Kim DJ. Effects of interscalene brachial plexus block to intra-operative hemodynamics and postoperative pain for arthroscopic shoulder surgery. Korean J Anesthesiol 2012; 62: 30-4. https://doi.org/10.4097/kjae.2012.62.1.30
  13. Song SY, Roh WS. Hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene brachial plexus blocks. Korean J Anesthesiol 2012; 62: 209-19. https://doi.org/10.4097/kjae.2012.62.3.209
  14. Conroy BP, Gray BC, Fischer RB, Del Campo LJ, Kenter K. Interscalene block for elective shoulder surgery. Orthopedics 2003; 26: 501-3.
  15. Laurila PA, Lopponen A, Kanga-Saarela T, Flinkkila T, Salomaki TE. Interscalene brachial plexus block is superior to subacromial bursa block after arthroscopic shoulder surgery. Acta Anaesthesiol Scand 2002; 46: 1031-6. https://doi.org/10.1034/j.1399-6576.2002.460818.x
  16. Lee JH, Cho SH, Kim SH, Chae WS, Jin HC, Lee JS, et al. Ropivacaine for ultrasound-guided interscalene block: 5 mL provides similar analgesia but less phrenic nerve paralysis than 10 mL. Can J Anaesth 2011; 58: 1001-6. https://doi.org/10.1007/s12630-011-9568-5
  17. Renes SH, Rettig HC, Gielen MJ, Wilder-Smith OH, van Geffen GJ. Ultrasound-guided low-dose interscalene brachial plexus block reduces the incidence of hemidiaphragmatic paresis. Reg Anesth Pain Med 2009; 34: 498-502. https://doi.org/10.1097/AAP.0b013e3181b49256
  18. Capdevila X, Dadure C, Bringuier S, Bernard N, Biboulet P, Gaertner E, et al. Effect of patient-controlled perineural analgesia on rehabilitation and pain after ambulatory orthopedic surgery: a multicenter randomized trial. Anesthesiology 2006; 105: 566-73. https://doi.org/10.1097/00000542-200609000-00022
  19. Axelsson K, Gupta A, Johanzon E, Berg E, Ekback G, Rawal N, et al. Intraarticular administration of ketorolac, morphine, and ropivacaine combined with intraarticular patient-controlled regional analgesia for pain relief after shoulder surgery: a randomized, double-blind study. Anesth Analg 2008; 106: 328-33. https://doi.org/10.1213/01.ane.0000297297.79822.00
  20. Liu SS, Richman JM, Thirlby RC, Wu CL. Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials. J Am Coll Surg 2006; 203: 914-32. https://doi.org/10.1016/j.jamcollsurg.2006.08.007
  21. Savoie FH, Field LD, Jenkins RN, Mallon WJ, Phelps RA 2nd. The pain control infusion pump for postoperative pain control in shoulder surgery. Arthroscopy 2000; 16: 339-42. https://doi.org/10.1016/S0749-8063(00)90076-8
  22. Buchheit T, Crews JC. Lateral cervical epidural catheter placement for continuous unilateral upper extremity analgesia and sympathetic block. Reg Anesth Pain Med 2000; 25: 313-7. https://doi.org/10.1097/00115550-200005000-00020
  23. Prusinkiewicz C, Lang S, Tsui BC. Lateral cervical epidural catheter placement using nerve stimulation for continuous unilateral upper extremity analgesia following a failed continuous peripheral nerve block. Acta Anaesthesiol Scand 2005; 49: 579-82. https://doi.org/10.1111/j.1399-6576.2005.00630.x
  24. Narouze SN, Govil H, Guirguis M, Mekhail NA. Continuous cervical epidural analgesia for rehabilitation after shoulder surgery: a retrospective evaluation. Pain Physician 2009; 12: 189-94.
  25. Davies RG, Myles PS, Graham JM. 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. Br J Anaesth 2006; 96: 418-26. https://doi.org/10.1093/bja/ael020
  26. Barrington MJ, Olive D, Low K, Scott DA, Brittain J, Choong P. Continuous femoral nerve blockade or epidural analgesia after total knee replacement: a prospective randomized controlled trial. Anesth Analg 2005; 101: 1824-9.
  27. Davies AF, Segar EP, Murdoch J, Wright DE, Wilson IH. Epidural infusion or combined femoral and sciatic nerve blocks as perioperative analgesia for knee arthroplasty. Br J Anaesth 2004; 93: 368-74. https://doi.org/10.1093/bja/aeh224
  28. Casati A, Vinciguerra F, Scarioni M, Cappelleri G, Aldegheri G, Manzoni P, et al. Lidocaine versus ropivacaine for continuous interscalene brachial plexus block after open shoulder surgery. Acta Anaesthesiol Scand 2003; 47: 355-60. https://doi.org/10.1034/j.1399-6576.2003.00065.x
  29. Tantry TP, Muralishankar B, Adappa KK, Bhandary S, Shetty P, Shenoy SP. Target-controlled infusion (Propofol) versus inhaled anaesthetic (Sevoflurane) in patients undergoing shoulder arthroscopic surgery. Indian J Anaesth 2013; 57: 35-40. https://doi.org/10.4103/0019-5049.108559

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