AAOS2017: LIA versus continuous insterscalene block in total shoulder arthroplasty

Study Type: Randomized Trial
OE Level of Evidence: N/A
Journal Level of Evidence: N/A
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Synopsis
99 patients scheduled for total shoulder arthroplasty were randomized to postoperative analgesia with either local infiltration analgesia or a continuous interscalene block for 48 hours postoperatively. Patients were assessed for perioperative pain and opioid consumption, as well as functional outcome at 1-month follow-up. Within the recovery Please login to view the rest of this report. Please login to view the rest of this report.
Why was this study needed now?
Local infiltration analgesia has been an emergent method of analgesia for orthopaedic procedures. While many studies have been conducted evaluating the efficacy of LIA in total knee and total hip procedures relative to appropriate nerve blocks, few, if any, have been performed in the setting of total shoulder arthroplasty. This study sought to evaluate the efficacy of LIA to the common interscalene block used in total shoulder arthroplasty.
What was the principal research question?
In total shoulder arthroplasty, is there any significant difference between local infiltration analgesia and interscalene block for postoperative analgesia when assessed over the first 48 hours postoperatively?
Population: 99 patients scheduled for anatomic or reverse total shoulder arthroplasty.
Intervention: LIA group: Intraoperatively, 110mL of ropivacaine 0.2%, ketoprofen 30mg, and epinephrine 0.5mg were injected next to the glenoid and humerus. An intraarticular catheter was placed at the end of the procedure, and on the first postoperative day, reinjection of 10mL ropivacaine 0.2%, ketoprofen 30mg and epinephrine was performed. The catheter was then removed.
Comparison: ISB group: A catheter was placed under ultrasound guidance, followed by the start of a continuous infusion of ropivacaine 0.2% for interscalene block. The infusion was stopped after 48 hours.
Outcomes: The primary outcome was pain on a numeric rating scale (NRS; 0-10). Secondary outcomes were opioid consumption, the incidence of postoperative complications, the Subjective Shoulder Value, and Constant score
Methods: RCT
Time: The primary endpoint was pain within the recovery room, and at 3, 6, 12, 24, 36, and 48 hours postoperatively. Follow-up was also scheduled at 1 month postoperatively.
What were the important findings?
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How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.