title: Digitally assisted acromioplasty: the effect of interscalene block on this new surgical technique.
abstract: 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.
authors.affiliation: Modbury Public Hospital, the Royal Adelaide Hospital, and the University of Adelaide, Adelaide, South Australia, Australia. orthodoc@ctel.com.au
authors.forename: G I
authors.initials: GI
authors.lastname: Bain
authors.forename: G
authors.initials: G
authors.lastname: Rudkin
authors.forename: A S
authors.initials: AS
authors.lastname: Comley
authors.forename: R J
authors.initials: RJ
authors.lastname: Heptinstall
authors.forename: M
authors.initials: M
authors.lastname: Chittleborough
mesh_terms: 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
chemical_list: D013693:Temazepam; D008874:Midazolam; D005283:Fentanyl; D002045:Bupivacaine; D015742:Propofol