Perioperative interscalene block versus intra-articular injection of local anesthetics for postoperative analgesia in shoulder surgery.
OBJECTIVE
Up to 70% of patients report moderate to severe pain after shoulder surgery, which can compromise early rehabilitation and functional recuperation. Postoperative shoulder pain control is improved with both interscalene block and intra-articular local anesthetic injection. The present study hypothesized that perioperative interscalene analgesia would offer pain control superior to perioperative intra-articular local anesthetics over the first 24 hours after surgery.


METHODS
Sixty patients undergoing shoulder surgery were randomly assigned to 1 of 2 groups: group IS had interscalene block with catheter installation, while group IA received intra-articular local anesthetic, also with catheter installation. All patients received 3 local anesthetic injections: 0.25 mL/kg of 2% lidocaine with epinephrine 2.5 microg/mL immediately before and after surgery, and 0.25 mL/kg of 0.5% bupivacaine with epinephrine 2.5 microg/mL 1 hour after the end of surgery, after which the catheters were removed, and no further local anesthetics were administered. Postoperative pain at rest was evaluated in the postanesthesia care unit (PACU), 3 hours, 6 hours and 24 hours after surgery. The area under the 24 hour pain over time curve was calculated. Hydromorphone consumption in the PACU and over 24 hours was recorded.


RESULTS
Pain scores (IS: 0.4 +/- 2 vs. IA: 4 +/- 3, P < .0001) and opioid consumption (IS: 0.7 mg +/- 1.4 vs. IA: 1.5 mg +/- 1.2, P = .02) were significantly higher in the PACU for group IA. However, neither the mean pain scores over the first day after surgery (IS: 5 +/- 2 vs. IA: 5 +/- 3; P = .4) nor 24-hour opioid consumption (IS: 4.4 mg +/- 2.8 vs. IA: 4.2 mg +/- 2.6; P = .4) were significantly higher in group IA.


CONCLUSIONS
PACU measurements of immediate postoperative pain and narcotic consumption favor perioperative interscalene analgesia over intra-articular analgesia. This benefit does not translate into lower overall pain for the first 24 hours after surgery.
Beaudet
Véronique
V
Department of Anesthesiology, University of Montreal, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
Williams
Stephan R
SR
Tétreault
Patrice
P
Perrault
Michel-Antoine
MA
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D001917:Brachial Plexus; D002045:Bupivacaine / Q000627:therapeutic use; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D004091:Hydromorphone / Q000627:therapeutic use; D007270:Injections, Intra-Articular; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D012785:Shoulder Joint / Q000601:surgery*; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D004091:Hydromorphone; D002045:Bupivacaine; D004837:Epinephrine