Inter-scalene block in day-case shoulder surgery

This study looked at the potential of using a combination of general anaesthesia and inter-scalene block (balanced anaesthesia) for providing day-case shoulder surgery services. One hundred and four patients undergoing shoulder surgery were audited using a questionnaire immediately after operation. All patients underwent shoulder surgery under a combination of general anaesthesia and inter-scalene block. The blocks were performed by a single anaesthetist experienced in the procedure. The pain scores were recorded based on visual analogue scale at 6, 12 and 48 h after operation. At 48 h overall pain control was assessed and patients were asked their opinion about having their operation done as a day-case. There were 52 males and 52 females with mean age of 49 years (range 18–85). Mean operation time was 47 min (range 25–90). Ninety-seven (93%) patients were pain free immediately after the operation. Seventy-six (73%) patients were pain free at 6 h and 39 (38%) at 12 h. Mean pain scores at 6 h was 3 and at 12 h was 4. One hundred and one patients said their pain was well controlled throughout the first 48 h by simple oral analgesics. Eighty-four (83%) patients expressed the opinion that they could have been managed as day case provided they were adequately counselled about the procedure. Six (5.7%) patients showed signs of Horner’s syndrome that resolved by 12 h. No other complications related to inter-scalene block occurred. This study has shown that inter-scalene block is a safe procedure providing sustained adequate pain relief after shoulder surgery. It could allow a high percentage of patients undergoing shoulder surgery to be discharged home on the day of the surgery.