Pain management in shoulder arthroplasty: a systematic review and network meta-analysis of randomized controlled trials

Xiao, Michelle; Cohen, Samuel; Cheung, Emilie V.; Freehill, Michael T.; Abrams, Geoffrey D.

doi:10.1016/j.jse.2021.06.008

Cited by 17 publications

(8 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All extracted data were verified by two other reviewers (YZ and ZPW). The risk of bias in each trial was assessed using the Cochrane Risk-of-bias tool for randomized trials (RoB 2) [ 15 ], which would provide a level of risk assessment in Domain 5 based on the answers, including “Randomization process”, “Deviations from intended interventions”, “Missing outcome data”, “Measurements of outcome”, and “Selection of the reported results”. The final judgment of the overall risk of bias was defined as “High” or “Low” risk of bias, or “Some concerns”.…”

Section: Methodsmentioning

confidence: 99%

Statistical fragility of reporting hemidiaphragmatic paralysis after brachial plexus blocks in randomized controlled trials: a systematic review

Luo

Liu

Zhu

et al. 2023

APS

View full text Add to dashboard Cite

To characterize the fragility index (FI) of statistically significant results reported in randomized controlled trials (RCTs) investigating the incidence of hemidiaphragmatic paralysis (HDP) after brachial plexus blocks. A systematic review of RCTs retrieved from the PubMed-Medline, Embase, and Web of Science electronic databases was conducted. All alternative RCTs published between January 2012 and October 2022 were identified. Only RCTs with two parallel arms designs, and reporting HDP as the primary outcome, statistical significance, and superiority results were selected. The FI was calculated according to Fisher’s exact test using previously described methods. In addition, the risk of bias was evaluated using the Cochrane Risk-of-Bias tool for randomized trials. The 23 RCTs that fulfilled the inclusion criteria had a median FI of 4 (interquartile range [IQR]2–8) and a median Fragility Quotient of 0.077 (IQR 0.038- 0.129). However, in 13 (56.5%) trials, the calculated FI value was ≤ 4. In 3/23 (13.0%) trials, the number of patients who dropped-out exceeded the FI value. Most trials (91.3%) had an overall low risk of bias. This systematic review revealed that the statistical results of RCTs investing HDP after brachial plexus blocks have tended to be fragile in the past decade. The FI should be an important aid in the interpretation of clinical results in combination with the P-value, particularly when statistically significant results are dependent on a small number of events. Future RCTs with larger sample sizes are needed to obtain more robust results in this field.

show abstract

Section: Methodsmentioning

confidence: 99%

Statistical fragility of reporting hemidiaphragmatic paralysis after brachial plexus blocks in randomized controlled trials: a systematic review

Luo

Liu

Zhu

et al. 2023

APS

View full text Add to dashboard Cite

show abstract

“…There was no significant difference in glucose control or complications between groups. An RCT 13 and a systematic review with meta-analysis of all prior Level-I and II RCTs 14 compared local injections with interscalene nerve blocks for postoperative pain control after shoulder arthroplasty and favored the use of interscalene blocks. In the systematic review 14 , 1,358 shoulders across 18 studies were analyzed.…”

Section: Shoulder Arthroplastymentioning

confidence: 99%

“…An RCT 13 and a systematic review with meta-analysis of all prior Level-I and II RCTs 14 compared local injections with interscalene nerve blocks for postoperative pain control after shoulder arthroplasty and favored the use of interscalene blocks. In the systematic review 14 , 1,358 shoulders across 18 studies were analyzed. At 4 and 8 hours postoperatively, patients who received local liposomal bupivacaine or ropivacaine injections had significantly more pain compared with patients who received either continuous or single-shot interscalene nerve blocks.…”

Section: Shoulder Arthroplastymentioning

confidence: 99%

What’s New in Shoulder and Elbow Surgery

Kim

Ricchetti

Hsu

2022

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Specific emphasis has been placed on higher-quality research (Level-I and II studies) and particularly relevant Level-III studies. Rotator Cuff RepairThe decision to indicate operative repair for degenerative rotator cuff tears is controversial. Kukkonen et al. 1 provided a mean 6.2-year follow-up in 150 patients who were >55 years of age; had small, full-thickness supraspinatus tears; and were randomized to physiotherapy only, acromioplasty and physiotherapy, or repair, acromioplasty, and physiotherapy. The mean change in Constant score (the primary outcome) was similar in the 3 groups, as were changes in the visual analog scale (VAS) pain and satisfaction scores. There was a significant progression of arthritis from baseline to follow-up for the entire cohort without a difference between groups. The authors suggested that operative repair is no better than conservative treatment and does not protect against degeneration of the glenohumeral joint.Long-term follow-up comparing single-row and doublerow repair techniques is uncommon. Lapner et al. 2 reported a 10-year follow-up to a previous 2-year report of a randomized controlled trial (RCT) of 90 patients comparing single-row and double-row repair. At 10 years, the Western Ontario Rotator Cuff Index (WORC) scores were higher in the double-row group. Between 2 and 10 years, significant decreases in the WORC and American Shoulder and Elbow Surgeons (ASES) scores were seen in the single-row repair group but not in the double-row repair group. Only 30 patients had 10-year ultrasound data, which demonstrated similar retear rates between groups: 23% for the single-row repair group compared with 42% for the double-row repair group (p = 0.418). The authors concluded that double-row fixation preserved joint function Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H167).

show abstract

“…They are superior to alternative analgesic modalities such as surgeon-administered local anesthetic infiltration and patient-controlled intravenous opioid analgesia 3 5 6. They are considered the gold standard in this surgical population due to titratability and control over duration 7…”

Section: Introductionmentioning

confidence: 99%

Rate of occurrence of respiratory complications in patients who undergo shoulder arthroplasty with a continuous interscalene brachial plexus block and associated risk factors

Geßner

Kou

et al. 2023

Reg Anesth Pain Med

View full text Add to dashboard Cite

IntroductionContinuous interscalene nerve block techniques are an effective form of targeted non-opioid postoperative analgesia for shoulder arthroplasty patients. One of the limiting risks, however, is potential phrenic nerve blockade with resulting hemidiaphragmatic paresis and respiratory compromise. While studies have focused on block-related technical aspects to limit the incidence of phrenic nerve palsy, little is known about other factors associated with increased risk of clinical respiratory complications in this population.MethodsA single-institution retrospective cohort study was conducted using electronic health records from adult patients who underwent elective shoulder arthroplasty with continuous interscalene brachial plexus blocks (CISB). Data collected included patient, nerve block, and surgery characteristics. Respiratory complications were categorized into four groups (none, mild, moderate, and severe). Univariate and multivariable analyses were conducted.ResultsAmong 1025 adult shoulder arthroplasty cases, 351 (34%) experienced any respiratory complication. These 351 were subdivided into 279 (27%) mild, 61 (6%) moderate, and 11 (1%) severe respiratory complications. In an adjusted analysis, patient-related factors were associated with an increased likelihood of respiratory complication: ASA Physical Status III (OR 1.69, 95% CI 1.21 to 2.36); asthma (OR 1.59, 95% CI 1.07 to 2.37); congestive heart failure (OR 1.99, 95% CI 1.19 to 3.33); body mass index (OR 1.06, 95% CI 1.03 to 1.09); age (OR 1.02, 95% CI 1.00 to 1.04); and preoperative oxygen saturation (SpO2). For every 1% decrease in preoperative SpO2, there was an associated 32% higher likelihood of a respiratory complication (OR 1.32, 95% CI 1.20 to 1.46, p<0.001).ConclusionsPatient-related factors that can be measured preoperatively are associated with increased likelihood of respiratory complications after elective shoulder arthroplasty with CISB.

show abstract

Pain management in shoulder arthroplasty: a systematic review and network meta-analysis of randomized controlled trials

Cited by 17 publications

References 46 publications

Statistical fragility of reporting hemidiaphragmatic paralysis after brachial plexus blocks in randomized controlled trials: a systematic review

Statistical fragility of reporting hemidiaphragmatic paralysis after brachial plexus blocks in randomized controlled trials: a systematic review

What’s New in Shoulder and Elbow Surgery

Rate of occurrence of respiratory complications in patients who undergo shoulder arthroplasty with a continuous interscalene brachial plexus block and associated risk factors

Contact Info

Product

Resources

About