Effects of Interscalene Nerve Block for Postoperative Pain Management in Patients after Shoulder Surgery

Abstract

Objectives. Shoulder surgery can produce severe postoperative pain and movement limitations. Evidence has shown that regional nerve block is an effective management for postoperative shoulder pain. The purpose of this study was to investigate the postoperative analgesic effect of intravenous patient-controlled analgesia (PCA) combined with interscalene nerve block in comparison to PCA alone after shoulder surgery. Methods. In this study, 103 patients receiving PCA combined with interscalene nerve block (PCAIB) and 48 patients receiving PCA alone after shoulder surgery were included. Patients' characteristics, preoperative shoulder score and range of motion, surgical and anesthetic condition in addition to visual analog scale (VAS) pain score, postoperative PCA consumption, and adverse outcomes were evaluated. Results. The results showed that PCA combined with interscalene nerve block (PCAIB) group required less volume of analgesics than PCA alone group in 24 hours (57.76 ± 23.29 mL versus 87.29 ± 33.73 mL, p < 0.001) and 48 hours (114.86 ± 40.97 mL versus 183.63 ± 44.83 mL, p < 0.001) postoperatively. The incidence of dizziness in PCAIB group was significantly lower than PCA group (resp., 1.9% and 14.6%, p = 0.005). VAS, nausea, and vomiting were less in group PCAIB, but in the absence of significant statistical correlation. Conclusion. Interscalene nerve block is effective postoperatively in reducing the demand for PCA analgesics and decreasing opioids-induced adverse events following shoulder surgery.

Effect of opioid dependence or abuse on opioid utilization after shoulder arthroplasty

“…Errors in documentation have the potential to skew results. Secondly, previous studies have shown that brachial plexus nerve blocks prior to shoulder surgery decrease postoperative opioid utilization[ 14 , 15 ], thus acting as a potential confounding variable. However, the proportion of patients receiving brachial plexus nerve blocks in this study was equivalent between study groups (Table 2 ) and thus did not likely affect the results.…”

Comparison of two different volumes of ropivacaine used in nerve stimulator guided inter-scalene block for arthroscopic shoulder surgery – A randomized controlled trial

“…We considered a difference of 20% in the mean 24-hour fentanyl consumption to be clinically significant. With an expected mean standard deviation of 150 mcg, expected mean 24-hour fentanyl consumption 500 μg,[ 5 ] an acceptable alpha error of 5%, and a power of the study of 80%, we required 28 patients in each group for a one-tailed analysis. Thus, with an added safety margin of 20%, we recruited 70 patients in the trial.…”

National Trends in Use of Regional Anesthesia and Postoperative Patterns of Opioid Prescription Filling in Shoulder Arthroscopy: A Procedure-Specific Analysis in Patients With or Without Recent Opioid Exposure

“…The reason is that the detection of differences in pain is based on subjective scales (eg, visual analog scale), and the amount of opioids used long term, after surgery, is subject to recall bias or depends on how honest a patient is. 10,27 In addition, many patients might fill an opioid prescription but not take the medication. In the last case, the number of opioid prescriptions filled is not representative of the amount of opioid consumed by the patient.…”

“…In the last case, the number of opioid prescriptions filled is not representative of the amount of opioid consumed by the patient. 10,23,39 Additional factors must be considered when investigating the pattern of opiate usage in surgical patients, as they constitute potential confounders. For example, any patient with a medical history of drug dependency or addiction is at higher risk for postoperative opiate misuse.…”