Effects of a Single-Dose Interscalene Block on Pain and Stress Biomarkers in Patients Undergoing Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

Liu, Xiao Ning; Noh, Youngmin; Yang, Cheol-Jung; Kim, Jung Uk; Chung, Moon Sang; Noh, Kyu Cheol

doi:10.1016/j.arthro.2016.09.018

Cited by 20 publications

(25 citation statements)

References 27 publications

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“… 33) Insulin sensitivity after operation decreases according to the magnitude of surgery because a major surgery may be more painful than a minor surgery. 34) Liu et al 16) reported that compared to the only general anesthesia group (20.39 ± 25.60 µU/mL), the insulin level significantly decreased in the general anesthesia with interscalene block group (10.55 ± 7.92 µU/mL) at POH 42 ( p = 0.048). Uchida et al 19) reported an insulin resistance during surgery and suggested that postoperative insulin resistance is partially prevented by epidural anesthesia.…”

Section: Discussionmentioning

confidence: 98%

“…To evaluate the stress biomarkers, blood sampling was conducted at 6:00 AM on the day of the surgery and at POH 24, 48, and 72. 16) Plasma insulin levels were determined by electrochemiluminescence using an immunoanalyzer (GAMMA-10; Shin Jin Medics, Goyang, Korea) in our hospital laboratory. Plasma DHEA-S levels were measured by a γ-counter (GAMMA-10, Shin Jin Medics) using a DHEA-S RIA CT kit (Immunotech, Monrovia, CA, USA) in the Seoul Clinical Laboratories.…”

Section: Methodsmentioning

confidence: 99%

“…The levels of the pain-related stress biomarkers, namely, insulin, DHEA-S, and fibrinogen, were also recorded. 16) …”

Section: Methodsmentioning

confidence: 99%

“…Postoperative pain is known to affect the stress reaction after surgery; this stress reaction is characterized by increased pituitary hormones or other biomarker secretion, which has secondary effects on the hormone secretion of the target organs. 16 17) Several studies have reported significant differences in the levels of stress biomarkers, namely, dehydroepiandrosterone sulfate (DHEA-S), 18) insulin, 19) and fibrinogen 20) between the patients with musculoskeletal pain and the patients without pain.…”

mentioning

confidence: 99%

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Effect of Surgical-Site, Multimodal Drug Injection on Pain and Stress Biomarkers in Patients Undergoing Plate Fixation for Clavicular Fractures

et al. 2018

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BackgroundSurgical-site, multimodal drug injection has recently evolved to be a safe and useful method for multimodal pain management even in patients with musculoskeletal trauma.MethodsFifty consecutive patients who underwent plating for mid-shaft and distal clavicular fractures were included in the study. To evaluate whether surgical-site injections (SIs) have pain management benefits, the patients were divided into two groups (SI and no-SI groups). The injection was administered between the deep and superficial tissues prior to wound closure. The mixture of anesthetics consisted of epinephrine hydrochloride (HCL), morphine sulfate, ropivacaine HCL, and normal saline. The visual analogue scale (VAS) pain scores were measured at 6-hour intervals until postoperative hour (POH) 72; stress biomarkers (dehydroepiandrosterone sulfate [DHEA-S], insulin, and fibrinogen) were measured preoperatively and at POH 24, 48, and 72. In patients who wanted further pain control or had a VAS pain score of 7 points until POH 72, 75 mg of intravenous tramadol was administered, and the intravenous tramadol requirements were also recorded. Other medications were not used for pain management.ResultsThe SI group showed significantly lower VAS pain scores until POH 24, except for POH 18. Tramadol requirement was significantly lower in the SI group until POH 24, except for POH 12 and 18. The mean DHEA-S level significantly decreased in the no-SI group (74.2 ± 47.0 µg/dL) at POH 72 compared to that in the SI group (110.1 ± 87.1 µg/dL; p = 0.046). There was no significant difference in the insulin and fibrinogen levels between the groups. The correlation values between all the biomarkers and VAS pain scores were not significantly different between the two groups (p > 0.05).ConclusionsAfter internal fixation of the clavicular fracture, the surgical-site, multimodal drug injection effectively relieved pain on the day of the surgery without any complications. Therefore, we believe that SI is a safe and effective method for pain management after internal fixation of a clavicular fracture.

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Section: Discussionmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

“…The levels of the pain-related stress biomarkers, namely, insulin, DHEA-S, and fibrinogen, were also recorded. 16) …”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Effect of Surgical-Site, Multimodal Drug Injection on Pain and Stress Biomarkers in Patients Undergoing Plate Fixation for Clavicular Fractures

et al. 2018

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“…In "Effects of a Single-Dose Interscalene Block on Pain and Stress Biomarkers in Patients Undergoing Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial," 2 Liu, Noh, Yang, Kim, Chung, and Noh not only examine the visual analog scale (VAS) postoperatively after rotator cuff surgery but delve into the response of stress biomarkers such as insulin, dehydroepiandrosterone (DHEA), and fibrinogen. We applaud the authors for their design of a prospective, randomized analysis of patients under general anesthesia (GA) with and without single-dose interscalene block (SISB).…”

mentioning

confidence: 99%

Editorial Commentary: Pain and Stress Response After Shoulder Arthroscopic Rotator Cuff Repair: Does Interscalene Block Make a Clinically Important Difference?

Rossi¹

2017

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Pain control after arthroscopic rotator cuff repair will invariably encompass a multimodal approach which will include, in some form, an anesthetic block. The authors of "Effects of a Single-Dose Interscalene Block on Pain and Stress Biomarkers in Patients Undergoing Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial" demonstrate better pain control and a decrease in levels of the stress biomarker insulin with the use of a single-dose interscalene block (SISB) and general anesthesia compared to general anesthesia alone. But a closer look at the minimal clinically important difference (MCID) becomes critically important when interpreting the results as the effect may be less than anticipated and the "rebound effect" plays an important role. The notoriously painful rotator cuff repair may need further evaluation beyond the first several days when looking from the patients' perspectives to impact overall satisfaction and utility.

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Comparison of Subacromial Injection and Interscalene Block for Immediate Pain Management After Arthroscopic Rotator Cuff Repair

Gross

Paganessi²,

Vazquez

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Effects of a Single-Dose Interscalene Block on Pain and Stress Biomarkers in Patients Undergoing Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

Cited by 20 publications

References 27 publications

Effect of Surgical-Site, Multimodal Drug Injection on Pain and Stress Biomarkers in Patients Undergoing Plate Fixation for Clavicular Fractures

Effect of Surgical-Site, Multimodal Drug Injection on Pain and Stress Biomarkers in Patients Undergoing Plate Fixation for Clavicular Fractures

Editorial Commentary: Pain and Stress Response After Shoulder Arthroscopic Rotator Cuff Repair: Does Interscalene Block Make a Clinically Important Difference?

Comparison of Subacromial Injection and Interscalene Block for Immediate Pain Management After Arthroscopic Rotator Cuff Repair

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