Abstract
Background: Arthroscopic rotator cuff repair surgery may lead to significant postoperative pain. Interscalene block (ISB) is an effective analgesic technique in these surgeries but there is a risk of the phrenic blockade. Subacromial local anesthetic infiltration is a phrenic sparing alternative technique for postoperative analgesia. The primary aim of our study was to compare the ISB with a continuous subacromial infusion (SAC) with regard to postoperative analgesia.Methods: This prospective randomized, interventional parallel arm trial was conducted in 60 ASA grade I and II, adult patients (30 patients in each group) posted for arthroscopic rotator cuff repair surgery. Patients were randomly assigned to receive either ultrasound-guided ISB (Group ISB: 15 ml of 0.75% ropivacaine) or continuous SAC (Group SAC: 15 ml 0.75% ropivacaine as a subacromial injection by ultrasound guidance and infusion of 3 ml/hour of 0.5% ropivacaine through the catheter placed subacromial by the surgeon). Intraoperative hemodynamic parameters, visual analog scores (VAS), and rescue analgesic requirements for 24 hours, patient satisfaction, and complications were recorded.Results: Rescue analgesic requirement was significantly higher in SAC at zero hours (P=0.000), while it was significantly higher in ISB at 12 hours (P=0.02). The VAS scores were comparable at all time points and patient satisfaction at 24 hours was similar. None of the patients had rated satisfaction related to pain relief as poor in any group. Complications like ptosis and motor weakness were seen only with ISB.Conclusion: Both the techniques provided effective analgesia and comparable patient satisfaction with lesser incidence of complications in the SAC group. ISB provided more effective immediate postoperative pain relief while SAC was more effective in delayed analgesia for arthroscopic rotator cuff repair surgeries. SAC can be considered a reasonably safe alternative to ISB in patients with contraindications to the latter.
Highlights
Arthroscopic rotator cuff surgery is associated with substantial pain [1]
Interscalene block (ISB) provided more effective immediate postoperative pain relief while subacromial infusion (SAC) was more effective in delayed analgesia for arthroscopic rotator cuff repair surgeries
Seventy patients between 18 and 60 years of age, posted for arthroscopic rotator cuff repair and acromioplasty surgery were assessed for eligibility, and after screening for exclusion criteria, remaining 60 patients were included in the present study (Figure 1)
Summary
Arthroscopic rotator cuff surgery is associated with substantial pain [1]. Optimal management of such pain is necessary as it adds to patient disability but may delay mobilization of shoulder contributing to adhesive capsulitis [2]. A variety of therapeutic modalities have been advocated for postoperative pain relief after shoulder surgery. These include regional anesthesia, intra-articular injection of local anesthetics (LA), intravenous patient-controlled analgesia (PCA) pumps, compression cooling devices, and oral analgesics [3]. The primary aim of our study was to compare the ISB with a continuous subacromial infusion (SAC) with regard to postoperative analgesia
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