title: Continuous interscalene analgesia for rotator cuff repair: a retrospective comparison of effectiveness and cost in 205 patients from a multi-provider private practice setting.
abstract: Several barriers exist to the routine use of continuous interscalene block (CISB) for postoperative analgesia following rotator cuff repair There is a perception that the technique is feasible only for single operators exposed to a high volume case load. The aim of this retrospective review was to compare the three commonly employed analgesic techniques following rotator cuff repair in a multi-provider setting. The techniques studied were CISB, combined single injection interscalene block with postoperative intermittent intra-articular local anaesthetic infiltration (SSISB/IA) and intermittent intra-articular only local anaesthetic infiltration (IA). The clinical records of 205 consecutive patients having open rotator cuff repair over an 18-month period in two private care facilities were reviewed. The primary outcome endpoint was total opioid/tramadol consumption during the period of an overnight hospital stay. The median total opioid and tramadol consumption (in intravenous mg equivalents of morphine) from admission to the post anaesthesia care unit until discharge from hospital was 5 mg in the CISB group and 10 mg for the SSISB/IA and IA groups (P < 0.0001). The proportion of subjects requiring more than one antiemetic for the same period was 1.9% in the CISB group, 16.4% for the SSISB/IA group and 36.1% for the IA group (P < 0.0001). Costs related to the analgesic technique were similar in each group. CISB following rotator cuff repair in a multi-provider setting was associated with reduced total opioid/tramadol and antiemetic consumption, and occurred without a significant increase in the monetary cost.
authors.affiliation: Department of Anaesthesia, Auckland City Hospital, New Zealand.
authors.forename: M J
authors.initials: MJ
authors.lastname: Fredrickson
authors.forename: A W
authors.initials: AW
authors.lastname: Stewart
mesh_terms: D000698:Analgesia / Q000191:economics* / Q000379:methods* / Q000706:statistics & numerical data; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000772:Anesthesia, Local / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D000932:Antiemetics / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage; D009407:Nerve Block / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000188:drug therapy; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy; D011331:Private Practice / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000601:surgery*; D014147:Tramadol / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000932:Antiemetics; D009294:Narcotics; D014147:Tramadol