Estudio comparativo de la eficacia del bloqueo supraclavicular en la artroscopia de hombro

Abstract

Objectives Our aim is to evaluate the efficacy of two anesthetic techniques for the treatment of the postoperative pain, as well as their influence on hospital stay, after surgery arthroscopic of shoulder. Materials and methods Retrospective study based on the collection of data from anesthesia histories and from of our postoperative acute pain unit, during a 6-months period. Cases of shoulder arthroscopies carried out during this period were selected and the patients were distributed in 2 groups depending on the anesthetic technique used: group I consisted of patients treated with locoregional anesthesia (interscalene and inter-sternocleidomastoid block) combined with general anesthesia. Group II was general anesthesia cases with intravenous analgesia. The recorded variables were the following: postoperative pain, both at rest and during exercise in the first 24 h, using a simple verbal scale (SVS); the presence of side effects, need of analgesic rescue and duration of hospital stay. In the cases where the patients were discharged from hospital in the first 24 h, a telephone consultation was carried out for the evaluation of the abovementioned variables. Statistical analysis: Student- t and Chi-square tests. A P<.05 was considered statistically significant. Results A total of 26 patients were included (14 cases in group I and 12 cases in group II). The analysis of the postoperative pain at rest in the first 24 h revealed that the SVS in group I was 1 for the percentile 75, whereas in group II it was 2. The pain on movement was 2.25 for group I, and 3 for group II, ( P<.05). There was only 1 case with need of rescue (7%) in the first group, compared to the 5 cases (41%) in the second group ( P<.05). There were no cases of postoperative nausea and vomiting in the combined anesthesia group, whereas in the group with general anesthesia there were 4 cases (33%), ( P<.05). The estimated surgical time for the first group was 125 min, compared to the estimated 116 min for group II ( p>.05). In the group of combined anesthesia the average duration of hospital stay was 36 h, compared to the 60 h average duration in the group of General Anesthesia. ( P<.05). Discussion The blockade of the brachial plexus over the clavicle combined with general anesthesia has shown greater efficacy in the control of perioperative pain, both at rest and during exercise than the general anesthesia with intravenous analgesia. In addition, the incidence of undesirable effects, the need of rescue and the duration of hospital stay were lower in the group of patients with the combined technique, without significant effects on the duration of operating room occupation.