Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques

Abstract

SummaryShoulder surgery is well recognised as having the potential to cause severe postoperative pain. The aim of this review is to assess critically the evidence relating to the effectiveness of regional anaesthesia techniques commonly used for postoperative analgesia following shoulder surgery. Subacromial ⁄ intra-articular local anaesthetic infiltration appears to perform only marginally better than placebo, and because the technique has been associated with catastrophic chondrolysis, it can no longer be recommended. All single injection nerve blocks are limited by a short effective duration. Suprascapular nerve block reduces postoperative pain and opioid consumption following arthroscopic surgery, but provides inferior analgesia compared with single injection interscalene block. Continuous interscalene block incorporating a basal local anaesthetic infusion and patient controlled boluses is the most effective analgesic technique following both major and minor shoulder surgery. However, interscalene nerve block is an invasive procedure with potentially serious complications and should therefore only be performed by practitioners with appropriate experience.

Local Anaesthesia Efficacy as Postoperative Analgesia for Open Shoulder Instability Surgery: A Prospective Randomised Controlled Study

“…The single local anaesthetic injection effectiveness for open shoulder surgery was previously poorly documented and not well defined [2,8,14], more data even if with discordant results have been reported that however were more related to the continuous infusion of anaesthetics and arthroscopic setting [5,9,[15][16][17]. Anyhow, a little clinical benefit of local infiltration was evidenced [3].…”

“…Discordant results have been reported regarding local injection of anaesthetics in the intra-articular region for control of postoperative pain after shoulder surgery [3,8], similar to subacromial injection [5,9,10] and block of the suprascapular nerve [11].…”

“…Postoperative pain is usually managed by a variety of methods, including single shot and continuous interscalenic brachial plexus block (IBPB), patient-controlled analgesia (PCA) with opioids, continuous wound infiltration with local anaesthetics [2,3].…”

“…Nonetheless, it can be associated with severe acute adverse effects that are potentially devastating in addition to complications involving the peripheral nervous system [4,5]. These latter events, even if reported to a lesser degree, are evident when large case studies are examined, and can lead to a high level of patient discomfort that may interfere with postoperative assessment and function [3,6,7].…”

“…Most of the studies in the literature have investigated a continuous local anaesthetic infiltration in arthroscopic shoulder surgery and not in open shoulder surgery and specifically in the antero-inferior shoulder surgery [2,3,5,9,10]. Furthermore, not all have compared the local infiltration anaesthesia and the IBPB with a control group using the same volume and dose of anaesthetic in order to provide rigour to the study and to give the most appropriate clinical evaluations and comparisons.…”