title: Post operative pain management in shoulder surgery: Suprascapular and axillary nerve block by arthroscope assisted catheter placement.
abstract: BACKGROUND
  Postoperative pain management is the part of shoulder surgery to improve patient satisfaction, start rehabilitation process rapidly and decrease for hospital stay. Various treatment modalities have been used for pain management, but they have some limitations, side effects and risks. Throughout intraoperative and postoperative period, nerve blocks have been used more popularly than others because of efficacy. For the regional nerve block, local anesthetic should be infiltrated close to the nerve for maximum effect. Consequently, aim of this study was to evaluate analgesic efficacy when catheters are placed with assistance of arthroscope to block suprascapular and axillary nerves in patients undergoing arthroscopic repair of rotator cuff under general anesthesia.
  
  
  METHODS
  24 patients (5 males, 19 females; mean age: 54.3 years) who underwent arthroscopic repair of rotator cuff between June 2014 and September 2014 and were catheterized to block suprascapular and axillary nerves during shoulder arthroscopy were included in the study. Clinical outcomes were assessed using visual analog scale (VAS) scores preoperatively and at 0 h, 6 h, 12 h, 18 h, 24 h, and postoperative day 2.
  
  
  RESULTS
  Preoperative and postoperative 0 h, 6 h, 12 h, 18 h, 24 h, and day 2 mean VAS scores were 6.38 ± 0.77, 0.44 ± 0.42, 0.58 ± 0.42, 0.63 ± 0.40, 0.60 ± 0.44, 0.52 ± 0.42, and 1.55 ± 0.46, respectively. No statistical difference was found among 0 h, 6 h, 12 h, 18 h, and 24 h time points; however, comparison of postoperative day 2 and postoperative 0 h, 6 h, 12 h, 18h and 24 h VAS scores showed statistically significant difference (P< 0.05). All patients were discharged at the end of 24 h with no complication. The mean time (in minutes) required for blocking suprascapular nerve and axillar nerve were 14.38 ± 3.21 and 3.75 ± 0.85, respectively.
  
  
  CONCLUSIONS
  These results demonstrated that blocking two nerves with arthroscopic approach was an excellent pain management method in postoperative period. Accordingly, patients could recover rapidly and patients' satisfaction could be improved.
authors.affiliation: Department of Orthopaedic Surgery, Koru Hospital, Ankara, Turkey.
authors.forename: H Çağdaş
authors.initials: HÇ
authors.lastname: Basat
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, Yüksek İhtisas University, Ankara, Turkey.
authors.forename: D Hakan
authors.initials: DH
authors.lastname: Uçar
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Armangil
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, Ufuk University, Ankara, Turkey.
authors.forename: Berk
authors.initials: B
authors.lastname: Güçlü
authors.affiliation: Department of Orthopaedic Surgery, Memorial Hospital, Ankara, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Demirtaş
keywords: Pain; Rotator cuff; arthroscopy; nerve block; rotator cuff rupture; shoulder arthroscopy; shoulder pain; suprascapular nerve block and axillary nerve block 