title: Interscalene brachial plexus block for outpatient shoulder arthroplasty: Postoperative analgesia, patient satisfaction and complications.
abstract: BACKGROUND
  Shoulder arthroplasty procedures are seldom performed on an ambulatory basis. Our objective was to examine postoperative analgesia, nausea and vomiting, patient satisfaction and complications of ambulatory shoulder arthroplasty performed using interscalene brachial plexus block (ISB).
  
  
  METHODS
  We prospectively examined 82 consecutive patients undergoing total and hemi-shoulder arthroplasty under ISB. Eighty-nine per cent (n=73) of patients received a continuous ISB; 11% (n=9) received a single-injection ISB. The blocks were performed using a nerve stimulator technique. Thirty to 40 mL of 0.5% ropivacaine with 1:400,000 epinephrine was injected perineurally after appropriate muscle twitches were elicited at a current of less than 0.5% mA. Data were collected in the preoperative holding area, intraoperatively and postoperatively including the postanesthesia care unit (PACU), at 24h and at seven days.
  
  
  RESULTS
  Mean postoperative pain scores at rest were 0.8 ± 2.3 in PACU (with movement, 0.9 ± 2.5), 2.5 ± 3.1 at 24h and 2.8 ± 2.1 at seven days. Mean postoperative nausea and vomiting (PONV) scores were 0.2 ± 1.2 in the PACU and 0.4 ± 1.4 at 24h. Satisfaction scores were 4.8 ± 0.6 and 4.8 ± 0.7, respectively, at 24h and seven days. Minimal complications were noted postoperatively at 30 days.
  
  
  CONCLUSIONS
  Regional anesthesia offers sufficient analgesia during the hospital stay for shoulder arthroplasty procedures while adhering to high patient comfort and satisfaction, with low complications.
authors.affiliation: School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Shah
authors.forename: Karen C
authors.initials: KC
authors.lastname: Nielsen
authors.forename: Larissa
authors.initials: L
authors.lastname: Braga
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pietrobon
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Klein
authors.forename: Susan M
authors.initials: SM
authors.lastname: Steele