A prospective study of two methods of analgesia in shoulder arthroscopic procedures as day case surgery

Debnath, Ujjwal K.; Goel, Vivek; Saini, Sahil; Trehan, Neev; Trehan, Ravi

doi:10.1016/j.jcot.2019.06.008

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…24 ASCR was performed for patients in relatively good general condition based on the American Society of Anesthesiologists physical status classification (grade, \3) disregarding chronologic age. 10,29 A total of 73 patients were included in the present study for analysis. Of those, 36 patients belonged to the younger adults group, and 37 patients belonged to the older adults group (age, 65 years) (Figure 1).…”

Section: Patient Selectionmentioning

confidence: 99%

Arthroscopic Superior Capsular Reconstruction for Older Patients With Irreparable Rotator Cuff Tears: A Comparative Study With Younger Patients

et al. 2021

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Background: Arthroscopic superior capsular reconstruction (ASCR) is a method for treating irreparable chronic rotator cuff tears. However, the extent to which ASCR can be performed with regard to the patient’s age has yet to be determined. Purpose: To compare the surgical outcomes of ASCR for the treatment of irreparable rotator cuff tears (IRCTs) in patients aged <65 years versus patients aged ≥65 years. Study Design: Cohort study; Level of evidence, 3. Methods: Of 105 patients with IRCTs who underwent ASCR between March 2013 and June 2020, 73 patients were enrolled in this study based on the selection criteria. Polypropylene mesh augmentation to the graft was used in 18 of 36 patients in the younger adults group (age, <65 years) and 20 of 37 patients in the older adults group (age, ≥65 years). The clinical and radiological outcomes were evaluated preoperatively and at the final clinical follow-up. The graft integrity status was evaluated using serial magnetic resonance imaging and set as the primary endpoint. Furthermore, subgroup analysis was performed based on age group and graft type. Results: The mean age of the patients was 59.2 ± 3.8 years in the younger adults group and 70.5 ± 4.1 years in the older adults group. Both groups showed improvement based on the clinical and radiological outcomes at the final follow-up. The mean American Shoulder and Elbow Surgeons scores improved from 52.3 ± 15.4 to 77.3 ± 13.5 in the younger adults group ( P < .001) and from 45.7 ± 16.1 to 76.6 ± 11.4 in the older adults group ( P < .001). The mean visual analog scale for pain scores improved from 5.5 ± 1.2 to 2.1 ± 0.9 in the younger adults group ( P < .001) and from 5.5 ± 1.4 to 2.1 ± 1.2 in the older adults group ( P < .001). The graft healing rate was significantly higher in the younger adults group (81%) than in the older adults group (65%) ( P = .049). Subgroup analysis showed that after mesh augmentation, the healing rate in the younger adults group (84%) was similar to that in the older adults group (85%) ( P = .299). Conclusion: ASCR resulted in a favorable surgical outcome for both younger and older adult patients with IRCT. The younger patients had lower graft failure rates and superior surgical outcomes. In older patients, ASCR using polypropylene mesh augmentation may reduce graft failure and result in surgical outcomes similar to those in younger patients.

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Section: Patient Selectionmentioning

confidence: 99%

Arthroscopic Superior Capsular Reconstruction for Older Patients With Irreparable Rotator Cuff Tears: A Comparative Study With Younger Patients

et al. 2021

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“…As shown by Scoggin et al, local anesthetics applied immediately before portal removal contributed to pain control in the postoperative period [12]. On the other hand, a comparison of intra-articular local anesthetic application with interscalene block and portals by Debnath et al showed poor analgesia control compared to interscalene block [13].…”

Section: Discussionmentioning

confidence: 97%

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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Efficacy and adverse effects of peripheral nerve blocks and local infiltration anesthesia after arthroscopic shoulder surgery: A Bayesian network meta-analysis

Liu

Li²,

Wang³

et al. 2022

Front. Med.

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Study objectiveTo quantitatively assess and compare the efficacy and adverse effects of six different peripheral nerve block techniques after arthroscopic shoulder surgery (ASS).DesignBayesian network meta-analysis.MethodsThe PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure database, Chinese Scientific Journal database, Wan Fang databases were searched to retrieve randomized clinical trials comparing interscalene brachial plexus block, continuous interscalene brachial plexus block, supraclavicular brachial plexus block, suprascapular nerve block, combined suprascapular and axillary nerve block and local infiltration analgesia on postoperative pain, opioid consumption, and adverse effects (defined as Horner’s syndrome, dyspnea, hoarseness, vomiting, and nausea) after ASS under general anesthesia (GA). Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias in the included studies.ResultsA total of 1,348 articles were retrieved initially and 36 randomized clinical trials involving 3,124 patients were included in the final analysis. The network meta-analysis showed that interscalene brachial plexus block was superior in reducing pain and opioid consumption compared to the five other interventions. However, adverse effects were reduced using suprascapular nerve block and combined suprascapular and axillary nerve block compared to interscalene brachial plexus block.ConclusionInterscalene brachial plexus block was superior in reducing pain and opioid consumption compared to other peripheral nerve blocks but had a higher frequency of adverse events.

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A prospective study of two methods of analgesia in shoulder arthroscopic procedures as day case surgery

Cited by 3 publications

References 22 publications

Arthroscopic Superior Capsular Reconstruction for Older Patients With Irreparable Rotator Cuff Tears: A Comparative Study With Younger Patients

Arthroscopic Superior Capsular Reconstruction for Older Patients With Irreparable Rotator Cuff Tears: A Comparative Study With Younger Patients

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

Efficacy and adverse effects of peripheral nerve blocks and local infiltration anesthesia after arthroscopic shoulder surgery: A Bayesian network meta-analysis

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