AAOS2017: Continuous vs. single-shot interscalene block after shoulder arthroplasty

Study Type: Randomized Trial
OE Level of Evidence: N/A
Journal Level of Evidence: N/A
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Synopsis
76 patients scheduled for shoulder arthroplasty were randomized to postoperative analgesia with either a continuous or single-shot interscalene block. Patients were assessed for pain, opioid consumption, the length of stay, and the incidence of adverse events. In addition, patients Please login to view the rest of this report. Please login to view the rest of this report.
Why was this study needed now?
Total shoulder arthroplasty is an effective surgical procedure used to address various pathologies of the shoulder; however, it can be associated with considerable postoperative pain. An interscalene block is often administered during these procedures to manage postoperative pain. Single-shot blocks are effective in immediate postoperative pain control, although the duration of effect may not be sufficient and "rebound pain" may be observed. Continuous infusion is a method to extend postoperative analgesia that may prevent rebound pain, however, the safety of a continuous infusion of local anesthetic is of concern. Therefore, a randomized controlled trial evaluating efficacy and safety of these two techniques was needed.
What was the principal research question?
In shoulder arthroplasty, is there any significant difference in postoperative analgesic efficacy between a single-shot and continuous interscalene block?
Population: 76 patients scheduled for shoulder arthroplasty. (50 patient underwent anatomic total shoulder arthroplasty, 21 underwent reverse shoulder arthroplasty, and 5 underwent hemiarthroplasty)
Intervention: Continuous ISB group: Preoperatively, patients were administered an interscalene block under ultrasound guidance using 30mL of 0.5% ropivacaine. A stimulating catheter was then placed, and continuous infusion of 0.2% ropivacaine at 8mL/hr was administered for a total of approximately 55 hours following the end of the procedure.
Comparison: Single-shot ISB group: Preoperatively, patients were administered an interscalene block under ultrasound guidance using 30mL of 0.5% ropivacaine
Outcomes: The postoperative pain was assessed on a visual analog scale (VAS; 0-10) and patient satisfaction was assessed on a 5-point Likert scale. Opioid consumption was recorded. The length of hospital stay, the incidence of catheter withdrawal, and the incidence of adverse events were also recorded.
Methods: RCT
Time: Not clearly stated within the conference abstract.
What were the important findings?
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The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.