Digitally assisted acromioplasty: the effect of interscalene block on this new surgical technique.
OBJECTIVE
Interscalene brachial plexus (ISBP) block has been shown to be safe and effective for shoulder surgery with significant benefits. The purpose of this study was to introduce the technique of digitally assisted acromioplasty and assess the effect of ISBP on rehabilitation.


METHODS
Randomized controlled prospective trial.


METHODS
In a randomized prospective trial of 40 patients undergoing acromioplasty under general anesthesia, 20 patients received an ISBP block (group 1) and 20 had no block (group 2). A digitally assisted acromioplasty was performed using a burr introduced via a posterior portal. The undersurface of the acromion was debrided, directing the burr with the surgeon's index finger introduced via a small lateral incision. Independent review was at day 1, day 2, week 1, week 6, and 1 year.


RESULTS
Group 1 had significantly greater shoulder motion and shoulder score, and less pain and analgesic requirements on the first day. These differences did not persist. Both groups had improved pain and function over time compared with preoperative scores.


CONCLUSIONS
ISBP provides superior initial results but does not offer any significant persistent functional or rehabilitative advantage in the medium to long term. Digitally assisted acromioplasty is simple to perform and does not violate the deltoid insertion.
Bain
G I
GI
Modbury Public Hospital, the Royal Adelaide Hospital, and the University of Adelaide, Adelaide, South Australia, Australia. orthodoc@ctel.com.au
Rudkin
G
G
Comley
A S
AS
Heptinstall
R J
RJ
Chittleborough
M
M
D000173:Acromioclavicular Joint / Q000601:surgery*; D000174:Acromion / Q000601:surgery*; D000203:Activities of Daily Living; D000284:Administration, Oral; D000328:Adult; D001340:Autonomic Nerve Block / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage; D003646:Debridement; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D011229:Preanesthetic Medication; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012782:Shoulder / Q000503:physiopathology / Q000601:surgery*; D000070599:Shoulder Injuries; D013693:Temazepam / Q000008:administration & dosage; D013813:Therapy, Computer-Assisted
D013693:Temazepam; D008874:Midazolam; D005283:Fentanyl; D002045:Bupivacaine; D015742:Propofol