Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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The Efficacy of Additional Intravenous Patient-controlled Analgesia to the Interscalene Block in Arthroscopic Shoulder Surgery: A Prospective Randomized Controlled Study

  • Shin, Sang-Jin (Department of Orthopaedic Surgery, Ewha Womans University School of Medicine) ;
  • Seo, Myeong-Jae (Department of Orthopaedic Surgery, Ewha Womans University School of Medicine) ;
  • Kim, Youn Jin (Department of Anesthesia and Pain Medicine, Ewha Womans University School of Medicine) ;
  • Baik, Hee Jung (Department of Anesthesia and Pain Medicine, Ewha Womans University School of Medicine)
  • Received : 2016.08.08
  • Accepted : 2016.09.21
  • Published : 2017.03.31
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Abstract

Background: The purpose is to determine the efficacy of additional intravenous patient-controlled analgesia (IV-PCA) by comparing the analgesic effects between interscalene block (ISB) combined with IV-PCA and single ISB after arthroscopic shoulder surgery. Methods: A total of 213 patients who underwent arthroscopic shoulder surgery were divided into two groups based on the type of perioperative anesthesia. The single ISB group included 100 patients, while the IV-PCA group included 113 patients. The visual analogue scale for pain (VAS pain) scores were assessed at 12, 24, and 48 hours postoperatively in accordance with shoulder pathology. Postoperative narcotics-related complications and consumption of additional non-steroidal anti-inflammatory drugs between the two groups were compared. Results: VAS pain showed no significant difference between the two groups at most points of the postoperative timeline, regardless of shoulder pathology, except in patients with rotator cuff repair at postoperative 24 hours. Although the IV-PCA group showed a statistically lower VAS pain score than the ISB group at postoperative 24 hours (p=0.04), the difference in the VAS pain score was only 9.0 mm in patients with rotator cuff repair. Narcotics-related complications were observed more frequently in the IV-PCA group than in the ISB group for patients with rotator cuff repair. Conclusions: Additional IV-PCA demonstrated no booster effect for immediate pain control in patients undergoing arthroscopic shoulder surgery with preoperative single ISB. Furthermore, patients with IV-PCA experienced greater narcotics-related complications.

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References

  1. Abdallah FW, Halpern SH, Aoyama K, Brull R. Will the real benefits of single-shot interscalene block please stand up? A systematic review and meta-analysis. Anesth Analg. 2015;120(5):1114-29. https://doi.org/10.1213/ANE.0000000000000688
  2. Sachs RA, Stone ML, Devine S. Open vs. arthroscopic acromioplasty: a prospective, randomized study. Arthroscopy. 1994;10(3):248-54. https://doi.org/10.1016/S0749-8063(05)80106-9
  3. Rawal N, Hylander J, Nydahl PA, Olofsson I, Gupta A. Survey of postoperative analgesia following ambulatory surgery. Acta Anaesthesiol Scand. 1997;41(8):1017-22. https://doi.org/10.1111/j.1399-6576.1997.tb04829.x
  4. Oh JH, Rhee KY, Kim SH, Lee PB, Lee JW, Lee SJ. Comparison of analgesic efficacy between single interscalene block combined with a continuous intra-bursal infusion of ropivacaine and continuous interscalene block after arthroscopic rotator cuff repair. Clin Orthop Surg. 2009;1(1):48-53. https://doi.org/10.4055/cios.2009.1.1.48
  5. Shin SW, Byeon GJ, Yoon JU, et al. Effective analgesia with ultrasound-guided interscalene brachial plexus block for postoperative pain control after arthroscopic rotator cuff repair. J Anesth. 2014;28(1):64-9. https://doi.org/10.1007/s00540-013-1681-x
  6. Jochum D, Iohom G, Bouaziz H. Ultrasound guidance, a winwin approach to peripheral nerve blockade. Curr Opin Anaesthesiol. 2013;26(5):600-4. https://doi.org/10.1097/01.aco.0000432518.78468.56
  7. Fredrickson MJ, Krishnan S, Chen CY. Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques. Anaesthesia. 2010;65(6):608-24. https://doi.org/10.1111/j.1365-2044.2009.06231.x
  8. Sinatra RS, Torres J, Bustos AM. Pain management after major orthopaedic surgery: current strategies and new concepts. J Am Acad Orthop Surg. 2002;10(2):117-29. https://doi.org/10.5435/00124635-200203000-00007
  9. Hudcova J, McNicol E, Quah C, Lau J, Carr DB. Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain. Cochrane Database Syst Rev. 2006;(4):CD003348.
  10. Lee LA, Caplan RA, Stephens LS, et al. Postoperative opioidinduced respiratory depression: a closed claims analysis. Anesthesiology. 2015;122(3):659-65. https://doi.org/10.1097/ALN.0000000000000564
  11. Palmer P, Ji X, Stephens J. Cost of opioid intravenous patientcontrolled analgesia: results from a hospital database analysis and literature assessment. Clinicoecon Outcomes Res. 2014;6:311-8.
  12. Woo JH, Kim YJ, Baik HJ, Han JI, Chung RK. Does intravenous ketamine enhance analgesia after arthroscopic shoulder surgery with ultrasound guided single-injection interscalene block?: a randomized, prospective, double-blind trial. J Korean Med Sci. 2014;29(7):1001-6. https://doi.org/10.3346/jkms.2014.29.7.1001
  13. 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(2):589-92. https://doi.org/10.1213/01.ANE.0000125112.83117.49
  14. Nisar A, Morris MW, Freeman JV, Cort JM, Rayner PR, Shahane SA. Subacromial bursa block is an effective alternative to interscalene block for postoperative pain control after arthroscopic subacromial decompression: a randomized trial. J Shoulder Elbow Surg. 2008;17(1):78-84. https://doi.org/10.1016/j.jse.2007.05.014
  15. Chao D, Young S, Cawley P. Postoperative pain management for arthroscopic shoulder surgery: interscalene block versus patient-controlled infusion of 0.25% bupivicaine. Am J Orthop (Belle Mead NJ). 2006;35(5):231-4.
  16. Webb D, Guttmann D, Cawley P, Lubowitz JH. Continuous infusion of a local anesthetic versus interscalene block for postoperative pain control after arthroscopic shoulder surgery. Arthroscopy. 2007;23(9):1006-11. https://doi.org/10.1016/j.arthro.2007.04.008
  17. Oh JH, Kim WS, Kim JY, Gong HS, Rhee KY. Continuous intralesional infusion combined with interscalene block was effective for postoperative analgesia after arthroscopic shoulder surgery. J Shoulder Elbow Surg. 2007;16(3):295-9. https://doi.org/10.1016/j.jse.2006.04.015
  18. Mariano ER, Afra R, Loland VJ, et al. Continuous interscalene brachial plexus block via an ultrasound-guided posterior approach: a randomized, triple-masked, placebo-controlled study. Anesth Analg. 2009;108(5):1688-94. https://doi.org/10.1213/ane.0b013e318199dc86
  19. Weber SC, Abrams JS, Nottage WM. Complications associated with arthroscopic shoulder surgery. Arthroscopy. 2002;18(2 Suppl 1):88-95. https://doi.org/10.1053/jars.2002.31801
  20. DeMarco JR, Componovo R, Barfield WR, Liles L, Nietert P. Efficacy of augmenting a subacromial continuous-infusion pump with a preoperative interscalene block in outpatient arthroscopic shoulder surgery: a prospective, randomized, blinded, and placebo-controlled study. Arthroscopy. 2011;27(5):603-10. https://doi.org/10.1016/j.arthro.2011.01.003
  21. Tashjian RZ, Deloach J, Porucznik CA, Powell AP. Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. J Shoulder Elbow Surg. 2009;18(6):927-32. https://doi.org/10.1016/j.jse.2009.03.021
  22. Dutton RP, Eckhardt WF 3rd, Sunder N. Total spinal anesthesia after interscalene blockade of the brachial plexus. Anesthesiology. 1994;80(4):939-41. https://doi.org/10.1097/00000542-199404000-00028
  23. Lenters TR, Davies J, Matsen FA 3rd. The types and severity of complications associated with interscalene brachial plexus block anesthesia: local and national evidence. J Shoulder Elbow Surg. 2007;16(4):379-87. https://doi.org/10.1016/j.jse.2006.10.007
  24. Lehmann LJ, Loosen G, Weiss C, Schmittner MD. Interscalene plexus block versus general anaesthesia for shoulder surgery: a randomized controlled study. Eur J Orthop Surg Traumatol. 2015;25(2):255-61. https://doi.org/10.1007/s00590-014-1483-3
  25. Singh A, Kelly C, O'Brien T, Wilson J, Warner JJ. Ultrasoundguided interscalene block anesthesia for shoulder arthroscopy: a prospective study of 1319 patients. J Bone Joint Surg Am. 2012;94(22):2040-6. https://doi.org/10.2106/JBJS.K.01418
  26. Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91(3):693-700. https://doi.org/10.1097/00000542-199909000-00022
  27. White LA, Vanarase M, Brockbank K, Barrett RF. Patientcontrolled analgesia and postoperative nausea and vomiting: efficacy of a continuous infusion of ondansetron. Anaesthesia. 2001;56(4):365-9. https://doi.org/10.1046/j.1365-2044.2001.01708-5.x
  28. Song JW, Park EY, Lee JG, Park YS, Kang BC, Shim YH. The effect of combining dexamethasone with ondansetron for nausea and vomiting associated with fentanyl-based intravenous patient-controlled analgesia. Anaesthesia. 2011;66(4):263-67. https://doi.org/10.1111/j.1365-2044.2011.06648.x
  29. White PF, Sacan O, Nuangchamnong N, Sun T, Eng MR. The relationship between patient risk factors and early versus late postoperative emetic symptoms. Anesth Analg. 2008;107(2):459-63. https://doi.org/10.1213/ane.0b013e31817aa6e4