Single-injection interscalene bupivacaine and dexamethasone for same-day discharge total shoulder arthroplasty: a case series

Effect of dexamethasone dose and route on the duration of interscalene brachial plexus block for outpatient arthroscopic shoulder surgery: a randomized controlled trial

“…6,10 We chose to use bupivacaine for our study because it was already in common use at our facility, and it would likely provide a longer block duration than ropivacaine, potentially offering a pain-free first postoperative night for most patients. 13,18 We respectively chose 8-mg and 4-mg doses of dexamethasone as the highest dose typically used in local practice and the lowest dose in the literature published at the time the study was being designed (4-10 mg). Two recent studies found that doses as low as 2.5 mg, administered by either the perineural 9 or intravenous 7 route, prolonged ISB duration vs placebo, but neither study compared the duration of ISB analgesia for different dexamethasone doses.…”

Outpatient Shoulder Arthroplasty—A Systematic Review

“…Following full text review, 26 articles were included in the review (Figure 1). Of the included studies, 18 articles discussed complications, readmissions, and safety, [16][17][18][19]21,22,[24][25][26][27][28][29][30][31][32][33]40,41 7 articles discussed patient selection, 21,[27][28][29][30][31]40 6 articles discussed pain management, 20,28,[34][35][36][37] 6 articles discussed the cost implications of outpatient surgery, 15,22,23,30,38,41 2 articles discussed patient satisfaction, 24,32 and 1 article discussed surgeon satisfaction. 15 The level of evidence of the included articles ranges from Level II to Level V.…”

“…Following full text review, 26 articles were included in the review (Figure 1). 16–41 Of the included studies, 18 articles discussed complications, readmissions, and safety, 16–19 , 21 , 22 , 24–33 , 40 , 41 7 articles discussed patient selection, 21 , 27–31 , 40 6 articles discussed pain management, 20 , 28 , 34–37 6 articles discussed the cost implications of outpatient surgery, 15 , 22 , 23 , 30 , 38 , 41 2 articles discussed patient satisfaction, 24 , 32...…”

“…37 One study reported on outpatient SA with SS interscalene nerve blockade. 34 One patient (5.1%) presented for a repeat block on post-operative day #1, and no other patients required ED presentation or readmission for pain control. Bean et al reported on outcomes with patients treated primarily with a periarticular local anesthetic injection.…”

“…Six articles described strategies for perioperative pain management, including reports on indwelling preoperative continuous nerve catheters, single shot (SS) interscalene nerve blockade (ISB) using ropivacaine or bupivacaine, and pericapsular local anesthetic injection at the time of surgery (Table 3). 20,28,[34][35][36][37] Studies with indwelling continuous nerve catheters reported no readmissions for anesthetic related complications, [35][36][37] though one study 35 in the ambulatory group reported 3/ 8 emergency room visits, 2 of which (25% of the ambulatory group) were related to pain or the catheter. Shah et al evaluated patients with primarily continuous nerve catheters (73/82, 89%) and a small subset of SS interscalene nerve blockade (9/82, 11%).…”