Comparison of local infiltration analgesia and interscalene block for postoperative pain management in shoulder arthroscopy: a prospective randomized controlled trial
Comparison of local infiltration analgesia and interscalene block for postoperative pain management in shoulder arthroscopy: a prospective randomized controlled trial
Background/aim: The aim of this study was to compare the effects of local infiltration analgesia and interscalene brachial plexus block techniques on postoperative pain control and shoulder functional scores in patients undergoing arthroscopic rotator cuff repair. Materials and methods: Sixty patients who underwent arthroscopic rotator cuff repair were prospectively included in the study. Patients were randomly divided into two groups. Group 1 was comprised of patients who had interscalene brachial plexus block, while group 2 was comprised of patients who had local infiltration analgesia. In group 1, interscalene block was applied with 20 mL 0.5% bupivacaine. In group 2, the Ranawat cocktail was used for local infiltration analgesia. Sixty milliliters of Ranawat cocktail was applied to the subacromial space and glenohumeral joint in equal amounts. Postoperative pain was assessed by the VAS score. Functional scores of the shoulder were also evaluated by Constant–Murley and UCLA scores. The time of first analgesic requirement and total analgesic consumption in the postoperative period were assessed. Results: The first analgesic requirement was significantly late in the interscalene brachial plexus block group (p = 0.000). There was no statistically significant difference between the groups in terms of total analgesic consumption (p = 0.204). In the postoperative 6th h, the VAS score was 2.43 in the interscalene brachial plexus block group, whereas 2.86 in the local infiltration analgesia group (p = 0.323). There was no statistically significant difference between the groups in terms of Constant–Murley shoulder and UCLA scores in the 3rd postoperative month (respectively, p = 0.929, p = 0.671). Besides, postoperative VAS scores and functional scores were negatively correlated (p < 0.01). Conclusion: Local infiltration analgesia is an effective alternative to interscalene brachial plexus block for postoperative pain management and total analgesic consumption in arthroscopic rotator cuff repair. However, the interscalene brachial plexus block provides a longer postoperative painless period.Key words: Functional scores, interscalene block, local infiltration analgesia, postoperative pain management, rotator cuff repair, shoulder arthroscopy
___
- 1. Bunker T. Rotator cuff disease. Current Orthopaedics 2002; 16(3): 223-233. doi: 10.1054/cuor.2002.0257
- 2. Sandow MJ, Schutz CR. Arthroscopic rotator cuff repair using a transosseous knotless anchor (ATOK). Journal of Shoulder and Elbow Surgery 2020 Mar; 29(3): 527-533. doi: 263 10.1016/j. jse.2019.07.017
- 3. Laurila PA, Lopponen A, Kanga-Saarela T, Flinkkila T, Salomaki TE. Interscalene brachial plexus block is superior to subacromial bursa block after arthroscopic shoulder surgery. Acta anaesthesiologica Scandinavica 2002; 46(8): 1031-1036. doi: 10.1034/j.1399-6576.2002.460818.x
- 4. Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S et al. Management of postoperative pain: a clinical practice guideline from the american pain society, the american society of regional anesthesia and pain medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Commi. The Journal of Pain 2016; 17(2): 131-157. doi: 10.1016/j.jpain.2015.12.008
- 5. Fredrickson MJ, Krishnan S, Chen CY. Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques. Anaesthesia 2010; 65(6): 608-624. doi: 10.1111/j.1365-2044.2009.06231.x
- 6. Gurger M, Ozer AB. A comparison of continuous interscalene block versus general anesthesia alone on the functional outcomes of the patients undergoing arthroscopic rotator cuff repair. European Journal of Orthopaedic Surgery & Traumatology 2019; 29(8): 1659-280 1666. doi: 10.1007/ s00590-019-02482-8
- 7. Ford E, Saini S, Szukics P, Assiamah AA, McMillan S. Patientreported outcomes after arthroscopic shoulder surgery with interscalene brachial plexus nerve block using liposomal bupivacaine: a prospective observational study. Surgical Technology International 2019; 35: 319-322.
- 8. Baskan S, Cankaya D, Unal H, Yoldas B, Taspinar V et al. Comparison of continuous interscalene block and subacromial infusion of local anesthetic for postoperative analgesia after open shoulder surgery. Journal of Orthopaedic Surgery 2017; 25(1): 2309499016684093. doi: 10.1177/2309499016684093
- 9. Souvatzoglou R, Gampopoulou Z, Aggelaki K, Mpaltzis G, Mavromati P et al. 199. Continuous interscalene nerve blockade versus continuous subacromial administration of ropivacaine for postoperative pain management in shoulder surgery. Regional Anesthesia & Pain Medicine 2007; 32(Suppl 1): 137 LP – 137. Available from: http://rapm.bmj.com/ content/32/Suppl_1/137.1.abstract
- 10. Maheshwari A V, Blum YC, Shekhar L, Ranawat AS, Ranawat CS. Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clinical Orthopaedics and Related Research 2009; 467(6): 1418-1423. doi: 10.1007/s11999-009-0728-7
- 11. Jayakumar T, Suhas BD, Avinash P. Post-operative pain management using local infiltration analgesia (LIA) in total knee arthroplasty (TKA): A prospective study. International Journal of Orthopaedics Sciences 2019; 5(3): 670-676. doi: 10.22271/ortho.2019.v5.i3l.1611
- 12. Kim J-H, Koh HJ, Kim DK, Lee H-J, Kwon K-H et al. Interscalene brachial plexus bolus block versus patientcontrolled interscalene indwelling catheter analgesia for the first 48 hours after arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery 2018 Jul; 27(7): 1243-1250. doi: 10.1016/j.jse.2018.02.048
- 13. Lenters TR, Davies J, Matsen FA 3rd. The types and severity of complications associated with interscalene brachial plexus block anesthesia: local and national evidence. Journal of Shoulder and Elbow Surgery 2007; 16(4): 379-387. doi: 10.1016/j.jse.2006.10.007
- 14. Nisar A, Morris MWJ, Freeman J V, Cort JM, Rayner PR et al. Subacromial bursa block is an effective alternative to interscalene block for postoperative pain control after arthroscopic subacromial decompression: a randomized trial. Journal of Shoulder and Elbow Surgery 2008;17(1): 78-84. doi: 10.1016/j.jse.2007.05.014
- 15. Webb D, Guttmann D, Cawley P, Lubowitz JH. Continuous infusion of a local anesthetic versus interscalene block for postoperative pain control after arthroscopic shoulder surgery. Arthroscopy : the journal of arthroscopic & related surgery 2007; 23(9): 1006-1011. doi: 10.1016/j.arthro.2007.04.008
- 16. Bjornholdt KT, Jensen JM, Bendtsen TF, Soballe K, Nikolajsen L. Local infiltration analgesia versus continuous interscalene brachial plexus block for shoulder replacement pain: a randomized clinical trial. European Journal of Orthopaedic Surgery & Traumatology 2015 Dec; 25(8): 1245-1252. doi: 10.1007/s00590-015-1678-2
- 17. Fu P, Wu Y, Wu H, Li X, Qian Q et al. Efficacy of intra-articular cocktail analgesic injection in total knee arthroplasty—a randomized controlled trial. The Knee 2009; 16(4): 280-284. doi: 10.1016/j.knee.2008.12.012
- 18. HE C, PENG J, LIU Z. Effect and safety of periarticular highdose bupivacaine injections during total knee arthroplasy in patients with heart diseases. Orthopedic Journal of China 2011; 2011(16): 4.
- 19. Wechalekar MD, Smith MD. Utility of arthroscopic guided synovial biopsy in understanding synovial tissue pathology in health and disease states. World journal of orthopedics 2014 Nov; 5(5): 566-573. doi: 10.5312/wjo.v5.i5.566
- 20. Dietz SO, Bartl C, Magosch P, Lichtenberg S, Habermeyer P. Intra-articular volume assessment in glenohumeral instability. Knee surgery, sports traumatology, arthroscopy 2006 Feb; 14(2): 189-192. doi: 10.1007/s00167-005-0661-6
- 21. Yi A, Avramis IA, Argintar EH, White ER, Villacis DC et al. Subacromial volume and rotator cuff tears: Does an association exist? Indian Journal of Orthopaedics 2015; 49(3): 300-303. doi: 10.4103/0019-5413.156201
- 22. Matziolis G, Roehner E, Windisch C, Wagner A. The volume of the human knee joint. Archives of Orthopaedic and Trauma Surgery 2015; 135(10): 1401-1403. doi: 10.1007/s00402-015- 2272-0
- 23. Iliaens J, Metsemakers W-J, Coppens S, Hoekstra H, Sermon A et al. Regional anaesthesia for surgical repair of proximal humerus fractures: a systematic review and critical appraisal. Archives of Orthopaedic and Trauma Surgery 2019 Dec;139(12): 1731-1741. doi: 10.1007/s00402-019-03253-0
- 24. Murthi AM, Vosburgh CL, Neviaser TJ. The incidence of pathologic changes of the long head of the biceps tendon. Journal of Shoulder and Elbow Surgery 2000; 9(5): 382-385. doi: 10.1067/mse.2000.108386
- 25. Beiranvand S, Moradkhani MR. Bupivacaine versus liposomal bupivacaine for pain control. Drug Research 2018; 68(7): 365- 369. doi: 10.1055/s-0043-121142
- 26. Yan Z, Chen Z, Ma C. Liposomal bupivacaine versus interscalene nerve block for pain control after shoulder arthroplasty: A meta-analysis. Medicine (Baltimore) 2017; 96(27): e7226. doi: 10.1097/MD.0000000000007226