Pain Management After Outpatient Shoulder Arthroscopy: A Systematic Review of Randomized Controlled Trials

Warrender, William J.; Syed, Usman Ali M.; Hammoud, Sommer; Emper, William; Ciccotti, Michael G.; Abboud, Joseph A.; Freedman, Kevin B.

doi:10.1177/0363546516667906

Cited by 111 publications

(93 citation statements)

References 69 publications

(115 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…2,3,12,13 A recent systematic review examining all modes of postoperative pain management following shoulder arthroscopy concluded that ISBPBs are superior to all other forms of postoperative pain control. 18 Existing studies examining ISBPBs are small and heterogeneous in terms of methodology, outcome measures, and therapeutic techniques/interventions, which creates difficulty in making comparisons. 2,9 Also, the majority of investigations have compared preoperative ISBPB with GA alone or with an ISBPB-GA combination.…”

Section: Résumémentioning

confidence: 99%

Pre- or postoperative interscalene block and/or general anesthesia for arthroscopic shoulder surgery: a retrospective observational study

Bosco

Zhou

Murdoch

et al. 2017

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Previously reported benefits of an ISBPB for arthroscopic shoulder surgery are confirmed. Postoperative ISBPBs may also be beneficial for reducing pain and opioid requirements and could be targeted for patients in severe pain upon emergence. A sufficiently powered randomized-controlled trial could determine the relative efficacy, safety, and associated financial implications associated with each method.

show abstract

Section: Résumémentioning

confidence: 99%

Pre- or postoperative interscalene block and/or general anesthesia for arthroscopic shoulder surgery: a retrospective observational study

Bosco

Zhou

Murdoch

et al. 2017

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…Unplanned day of surgery admissions were significantly lower in the nerve block group, which is consistent with the trial data demonstrating improved early pain control and shorter postanesthesia care unit stays with nerve blocks. 13 However, this early benefit did not impact postdischarge outcomes, as emergency department visits and readmissions did not differ between groups. The reasons for emergency department visits may provide some insight into this finding.…”

Section: Discussionmentioning

confidence: 92%

“…11 Recent systematic reviews suggest that nerve blocks provide the highest degree of acute postoperative pain relief in ambulatory shoulder surgery patients; however, highquality evidence supporting a positive impact of regional anesthesia on longer-term outcomes is lacking. [12][13][14] Population-based studies could help to address this lack of data; however, available studies are at risk of bias as they have used exposures and outcomes that have not been…”

mentioning

confidence: 99%

Peripheral Nerve Blocks for Ambulatory Shoulder Surgery

et al. 2019

View full text Add to dashboard Cite

Background: Nerve blocks improve early pain after ambulatory shoulder surgery; impact on postdischarge outcomes is poorly described. Our objective was to measure the association between nerve blocks and health system outcomes after ambulatory shoulder surgery. Methods:We conducted a population-based cohort study using linked administrative data from 118 hospitals in Ontario, Canada. Adults having elective ambulatory shoulder surgery (open or arthroscopic) from April 1, 2009, to December 31, 2016, were included. After validation of physician billing codes to identify nerve blocks, we used multilevel, multivariable regression to estimate the association of nerve blocks with a composite of unplanned admissions, emergency department visits, readmissions or death within 7 days of surgery (primary outcome) and healthcare costs (secondary outcome). Neurology consultations and nerve conduction studies were measured as safety indicators.results: We included 59,644 patients; blocks were placed in 31,073 (52.1%). Billing codes accurately identified blocks (positive likelihood ratio 16.83, negative likelihood ratio 0.03). The composite outcome was not significantly different in patients with a block compared with those without (2,808 [9.0%] vs. 3,424 [12.0%]; adjusted odds ratio 0.96; 95% CI 0.89 to 1.03; P = 0.243). Healthcare costs were greater with a block (adjusted ratio of means 1.06; 95% CI 1.02 to 1.10; absolute increase $325; 95% CI $316 to $333; P = 0.005). Prespecified sensitivity analyses supported these results. Safety indicators were not different between groups. conclusions:In ambulatory shoulder surgery, nerve blocks were not associated with a significant difference in adverse postoperative outcomes. Costs were statistically higher with a block, but this increase is not likely clinically relevant. (ANESTHESIOLOGY 2019; 131:1254-63) editor'S PerSPective What We Already Know about This Topic • The use of peripheral nerve blocks after ambulatory shoulder surgery is increasing • While short-term pain control is improved by nerve blocks in this context, the relationship with postdischarge outcomes is unclear What This Article Tells Us That Is New • Peripheral nerve blocks are associated with a decrease in unplanned admissions after ambulatory shoulder surgery • There is no associated improvement in other postoperative outcomes such as emergency department visits, readmissions, mortality, or costs Acute pain 302 (1.1) 434 (1.4) Surgical dressing or suture 168 (0.6) 102 (0.3) bleeding 94 (0.3) 69 (0.2) Pain in joint 50 (0.2) 68 (0.2) Urinary retention 76 (0.3) 64 (0.2) eD, emergency department; PNb, peripheral nerve block.

show abstract

“…However, ISBB is associated with serious complications . Thus, numerous alternative techniques have been investigated, but have been found to be nonequivalent analgesic methods when compared with ISBB . One new study showed that the US‐guided supraclavicular block, combined with a suprascapular block, was an effective alternative to the interscalene block for postoperative analgesia after shoulder instability surgery .…”

Section: Discussionmentioning

confidence: 99%

“…Different analgesic methods, such as interscalene brachial plexus blocks (ISBBs), suprascapular blocks, and intra‐articular injections, have been performed to reduce shoulder pain and opioid‐related side effects, including emesis, itching, sleep disturbance, and constipation, after arthroscopic shoulder surgery. Most studies that have evaluated postoperative pain management after arthroscopic shoulder surgery have found that ISBB was superior to the other techniques . Therefore, ISBB has become a widely preferred technique as the sole anesthesia or an adjuvant to general anesthesia in shoulder surgeries .…”

Section: Introductionmentioning

confidence: 99%

Comparison of Ultrasound‐Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Postoperative Pain Management After Arthroscopic Shoulder Surgery

Karaman

Aşçi

et al. 2018

Pain Practice

View full text Add to dashboard Cite

Background The interscalene brachial plexus block (ISBB) is an effective procedure for minimizing postoperative opioid consumption and pain following arthroscopic shoulder surgery. The ultrasound (US)‐guided supraclavicular brachial plexus block (SCBB) seems to be an alternative technique for arthroscopic shoulder surgery. However, evidence is lacking regarding the impact of SCBB on postoperative pain management and recovery after arthroscopic shoulder surgery. The aim of this study was to compare the effects of SCBB with ISBB in terms of postoperative pain and quality of recovery after arthroscopic shoulder surgery. Methods A total of 62 adult patients scheduled for arthroscopic shoulder surgery under general anesthesia were randomized into 2 groups to receive either ISBB (IB group, n = 31) or SCBB (SB group, n = 29) with 20 mL of 0.25% bupivacaine under US guidance. Assessments included postoperative pain scores, additional analgesic requirement, timing of the first analgesic requirement, Quality of Recovery‐40 (QoR‐40) scores, block characteristics, and side effects. Results No significant differences were found between the 2 groups for pain scores (P = 0.34), timing of first analgesic requirement (P = 0.30), additional analgesic requirement (P = 0.34), or QoR‐40 scores (P = 0.13). The block characteristics regarding procedure time (P = 0.95), block failure, and onset time of sensory blockade (P = 0.33) were similar. Horner's syndrome occurred in 8 patients in the IB group and 1 patient in the SB group (P = 0.015). Conclusions This study showed that US‐guided SCBB is as effective as ISBB in reducing postoperative pain and improving the quality of recovery for arthroscopic shoulder surgery.

show abstract

Pain Management After Outpatient Shoulder Arthroscopy: A Systematic Review of Randomized Controlled Trials

Abstract: On the basis of the evidence in this review, we recommend the use of ISBs as the most effective analgesic for outpatient arthroscopic shoulder surgery.

Cited by 111 publications

References 69 publications

Pre- or postoperative interscalene block and/or general anesthesia for arthroscopic shoulder surgery: a retrospective observational study

Pre- or postoperative interscalene block and/or general anesthesia for arthroscopic shoulder surgery: a retrospective observational study

Peripheral Nerve Blocks for Ambulatory Shoulder Surgery

Comparison of Ultrasound‐Guided Supraclavicular and Interscalene Brachial Plexus Blocks in Postoperative Pain Management After Arthroscopic Shoulder Surgery

Contact Info

Product

Resources

About