Comparison of interscalene block, general anesthesia, and intravenous analgesia for out-patient shoulder reduction

Janett Kreutziger,Richard F Herzog,Sven Fischer,Stefan Zbinden,Philipp Honigmann,Desmond Hirschi

doi:10.1007/s00540-019-02624-6

Janett Kreutziger, Richard F Herzog + Show 4 more

Open Access

https://doi.org/10.1007/s00540-019-02624-6

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Abstract

PurposeShoulder dislocation is often associated with intense pain, and requires urgent pain therapy and reduction. Interscalene block, general anesthesia, or intravenous analgesia alone are applied procedures that facilitate shoulder reduction by the surgeon and ease patients’ pain. This study was conducted to compare procedure times, patient satisfaction, side-effects, and clinical outcome of these clinical procedures.MethodsRetrospective chart analysis was performed for all patients treated at the Emergency Department of a primary care hospital. In addition, standardized telephone interviews were conducted. Subjective clinical outcome and patient satisfaction (SF-36, Quick-DASH, ZUF-8) were measured with the standardized questionnaires.ResultsThe shortest overall procedure time [67.5 min (48.8–93.5 min), P = 0.003] was found in patients with interscalene block. The advantage of general anesthesia was the shortest anesthesia induction time [10 min (7.8–10 min), P < 0.0001]; reduction time [6 min (4.3–6 min), P = 0.039]; and time to discharge [90 min (67.5–123.8 min), P = 0.0001] were significantly prolonged in comparison to interscalene block [5 min (1–5 min) and 45 min (2–67.5 min)]. The longest reduction time [11 min (10–13.5 min), P = 0.0008] was seen in patients in the intravenous analgesia group. Overall, patient satisfaction was greater in patients with regional as compared to general anesthesia [measured by ZUF-8: 12 (9–15) vs. 17 (12–24), P = 0.03]. Subjective clinical outcome (SF-36, DASH) was comparable among the three groups. There was one immediately identified esophageal intubation in the general anesthesia group.ConclusionsOut-patient shoulder reduction can be accomplished no matter whether general anesthesia, regional anesthesia, or intravenous analgesia alone was administered. Clinical outcome as measured by SF-36 and DASH was comparable among the three groups, but the shortest overall procedure time and greater patient satisfaction were found in patients with interscalene block.

Highlights

Shoulder dislocation is often associated with intense pain and requires urgent and efficient analgesic therapy
This study aimed to compare these methods regarding overall procedure time, patient satisfaction and clinical outcome as measured with two standardized questionnaires: short SF-36
Among the patients who underwent regional or general anesthesia, there was no one with pre-existing recurrent nerve paralysis or severe chronic obstructive pulmonary disease

Summary

Introduction

Shoulder dislocation is often associated with intense pain and requires urgent and efficient analgesic therapy. General or regional anesthesia (interscalene block), or intravenous analgesia alone are alternate, applied procedures that allow the surgeon to reduce the shoulder dislocation and free of or with little pain to the patient [1,2,3,4,5]. This study aimed to compare these methods regarding overall procedure time, patient satisfaction (measured with a questionnaire: German-language version of the Client Satisfaction Questionnaire CSQ-8 [6, 7], and pain rated on the numerical rating scale, NRS [8]) and clinical outcome as measured with two standardized questionnaires: short SF-36. (German-language version) [9] and Quick-DASH (disability arm–shoulder–hand) [10]. Both evaluate the subjective allocation of health status regarding the shoulder and the extent of limitation of everyday life.

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