Intra-articular injection versus interscalene brachial plexus block for acute-phase postoperative pain management after arthroscopic shoulder surgery |
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| Affiliation: | 1. Dept. of Anesthesiology, Wakamatsu Hospital of the University of Occupational and Environmental Health, 1-17-1, Hamamachi Wakamatsu, Kitakyushu, Fukuoka, 808-0024, Japan;2. Dept. of Orthopaedic Surgery, Wakamatsu Hospital of the University of Occupational and Environmental Health, 1-17-1, Hamamachi Wakamatsu, Kitakyushu, Fukuoka, 808-0024, Japan;3. Dept. of Anesthesiology, Hospital of the University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi, Kitakyushu, Fukuoka, 807-8556, Japan;1. Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan;2. Information Management Centre, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan;3. Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan;1. Department of Orthopaedic, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, 054000, China;2. Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China;1. Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, Hiroshima, 734-8551, Japan;2. Department of Orthopaedic Surgery, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijo, Higashi-Hiroshima, Hiroshima, 739-0041, Japan;1. Department of Orthopaedic Surgery, Nakagami Hospital, Japan;2. Upper Extremity Center of Joint Replacement and Endoscopic Surgery, Hokushin Hospital, Japan;3. Rehabilitation Clinic Yamaguchi, Japan;4. Department of Orthopaedic Surgery, University of the Ryukyus School of Medicine, Japan;1. Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan;2. Niigata Spine Center, Kameda Daiichi Hospital, Niigata, Japan;3. Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma, Niigata, Japan;1. Nara Prefecture General Medical Center, Narshi, Nara, 6308581 Japan;2. Kokuho Chuo Hospital, Shiki-gun, Nara, 6360302 Japan;3. Imperial Gift Saiseikai Nara Hospital, Nara-shi Nara, 6308145 Japan;4. Nara Medical University, School of Medicine, Kashihara-shi, Nara, 6348522 Japan |
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| Abstract: | BackgroundThe minimally invasive approach of arthroscopic shoulder surgery is beneficial; however, for optimal outcomes, perioperative pain management is essential. This cross-sectional study aimed to examine the analgesic effectiveness of intra-articular injection (IA) versus interscalene brachial plexus block (ISPB) among patients treated with arthroscopic shoulder surgeries.MethodsWe reviewed 100 consecutive patients who underwent shoulder arthroscopic surgery, of whom 50 each underwent IA (February 2019─January 2020; IA group) and ISPB (October 2018─July 2019; ISPB group). The primary outcome was the postoperative pain score measured using a Wong–Baker FACES Pain Rating Scale preoperatively and at 2, 6, 12, 24, and 48 h postoperatively. We performed multiple regression analysis to examine whether IA/ISPB selection is associated with acute-phase postoperative pain and adjusted for intra-articular injection, interscalene brachial plexus block, postoperative pain management, arthroscopic shoulder surgery, IA with 10 mg of morphine previously reported prognostic factors for postoperative pain (e.g., surgical procedures, operative time, older age, and preoperative pain). Furthermore, we examined induction time, total pentazocine dosage, and total postoperative nausea and vomiting (PONV) events.ResultsThere were no significant differences between the IA and ISPB groups in perioperative pain control during the acute-phase periods (p = 0.12, repeated analysis of variance). The difference in anesthesia method was not a prognostic factor for acute-phase postoperative pain (p = 0.11). The IA group (15.06 ± 4.00 min) had a significantly shorter mean anesthesia induction time than the ISPB group (29.23 ± 9.22 min) (p = 0.0001). There was no significant between-group difference in the total pentazocine dosage during the first 7 days (p = 0.3934) postoperatively. PONV was observed in eight (17.0%) and two (4.2%) patients in the IA and ISPB groups, respectively. There was no significant between-group difference in the PONV incidence (p = 0.1582).ConclusionsThere was no significant difference in acute-phase postoperative pain management between the IA and ISPB groups. The induction time was significantly shorter in IA.IRBApproval number: UOEHCRB20-078, IRB approval date: September 9th, 2020; study duration: October 2018 to January 2020. |
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