Does patient-controlled continuous interscalene block improve early functional rehabilitation after open shoulder surgery?
BACKGROUND
Early mobilization after shoulder surgery plays a vital role in successful functional rehabilitation. However, postoperative pain often reduces, or even prevents, effective physiotherapy. We investigated the effect of analgesia via patient-controlled interscalene technique on early functional rehabilitation after open shoulder surgery.


METHODS
Eighty-seven patients were randomly assigned to one of two groups: patient-controlled continuous interscalene block (PCISB) and patient-controlled i.v. (opioid) analgesia (PCA). Interscalene block was performed preoperatively; otherwise analgesic protocols were started in the postanesthesia care unit and were continued for 72 h. Physiotherapy was performed for 60 min a day on day 2 and 3 after surgery according to a standardized protocol. Maximum mobility was defined as the range of motion that could be achieved with pain as the limiting factor. Efficiency of functional rehabilitation was evaluated 1 day before and 3 days after surgery with the help of a multimodal scoring system (Constant-Score) that evaluates pain, daily life activity, strength and range of motion. Maximum intensity of pain was also monitored via Visual Analog Scales for the first 72 h after surgery and during in-hospital physiotherapy.


RESULTS
Constant-Score rates were significantly improved by the interscalene block. However, no significant differences in mobility and strength sub-scores were observed between the groups. Compared with PCA, PCISB proved to be beneficial concerning pain at rest at 6 h (P < 0.001), 24 h (P = 0.044), and 72 h (P = 0.013) and for pain during physiotherapy at 48 h after surgery (P = 0.016).


CONCLUSIONS
Compared with opioid-based PCA, PCISB improved analgesia, but not function, during early rehabilitation of the shoulder joint.
Hofmann-Kiefer
Klaus
K
Clinic of Anesthesiology/Critical Care Medicine and Pain Therapy, Ludwig-Maximilians-University, City of Munich, Germany. klaus.hofmann-kiefer@med.uni-muenchen.de
Eiser
Tim
T
Chappell
Daniel
D
Leuschner
Stephan
S
Conzen
Peter
P
Schwender
Dirk
D
D000577:Amides / Q000008:administration & dosage; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007592:Joint Diseases / Q000188:drug therapy / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D009407:Nerve Block; D019637:Orthopedic Procedures / Q000009:adverse effects*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D000077212:Ropivacaine; D017006:Rotator Cuff / Q000601:surgery; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery; D020069:Shoulder Pain / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D013997:Time Factors
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D005283:Fentanyl