Perioperative interscalene block versus intra-articular injection of local anesthetics for postoperative analgesia in shoulder surgery

Véronique Beaudet, Stephan R Williams, Patrice Tétreault, Michel-Antoine Perrault
Regional Anesthesia and Pain Medicine 2008, 33 (2): 134-8

BACKGROUND AND OBJECTIVES: Up to 70% of patients report moderate to severe pain after shoulder surgery, which can compromise early rehabilitation and functional recuperation. Postoperative shoulder pain control is improved with both interscalene block and intra-articular local anesthetic injection. The present study hypothesized that perioperative interscalene analgesia would offer pain control superior to perioperative intra-articular local anesthetics over the first 24 hours after surgery.

METHODS: Sixty patients undergoing shoulder surgery were randomly assigned to 1 of 2 groups: group IS had interscalene block with catheter installation, while group IA received intra-articular local anesthetic, also with catheter installation. All patients received 3 local anesthetic injections: 0.25 mL/kg of 2% lidocaine with epinephrine 2.5 microg/mL immediately before and after surgery, and 0.25 mL/kg of 0.5% bupivacaine with epinephrine 2.5 microg/mL 1 hour after the end of surgery, after which the catheters were removed, and no further local anesthetics were administered. Postoperative pain at rest was evaluated in the postanesthesia care unit (PACU), 3 hours, 6 hours and 24 hours after surgery. The area under the 24 hour pain over time curve was calculated. Hydromorphone consumption in the PACU and over 24 hours was recorded.

RESULTS: Pain scores (IS: 0.4 +/- 2 vs. IA: 4 +/- 3, P < .0001) and opioid consumption (IS: 0.7 mg +/- 1.4 vs. IA: 1.5 mg +/- 1.2, P = .02) were significantly higher in the PACU for group IA. However, neither the mean pain scores over the first day after surgery (IS: 5 +/- 2 vs. IA: 5 +/- 3; P = .4) nor 24-hour opioid consumption (IS: 4.4 mg +/- 2.8 vs. IA: 4.2 mg +/- 2.6; P = .4) were significantly higher in group IA.

CONCLUSIONS: PACU measurements of immediate postoperative pain and narcotic consumption favor perioperative interscalene analgesia over intra-articular analgesia. This benefit does not translate into lower overall pain for the first 24 hours after surgery.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"