Interscalene Brachial Plexus Block for Arthroscopic Shoulder Surgery

Abstract

Shoulder arthroscopy is currently one of the more common orthopaedic procedures, with an estimated 1.4 million procedures performed per year worldwide1. Many of these procedures are being performed on an outpatient basis and present substantial postoperative pain control challenges to the surgeon and anesthesiologist. An integral component of successful ambulatory surgical treatment is achieving and maintaining adequate pain management during the early postoperative course. The pain during the first twenty-four to forty-eight hours after arthroscopic shoulder surgery is often equivalent to that after open surgery, with 30% of patients reporting severe pain on the first postoperative day2. In a study of more than 15,000 outpatient surgical procedures from nine different surgical specialties, pain was responsible for 12% of the unplanned postoperative hospital admissions3. A retrospective review of 222 shoulder arthroscopy cases revealed a 2% rate of unplanned overnight admission because of pain symptoms4. Additionally, postoperative pain may instigate endocrine and metabolic responses, autonomic reflexes, nausea, and constipation that potentially lead to delayed postoperative rehabilitation, adhesive capsulitis, hospital admission, and loss of work days5-7. As a result, many different modalities have been described in both the orthopaedic and anesthesiology literature to minimize postoperative pain following ambulatory surgery8. Traditionally, these surgical procedures were performed under general anesthesia with infiltration of local anesthetic and parenteral administration of opioids to achieve early postoperative pain relief. Over forty years ago, Winnie reported the results of an interscalene brachial plexus block involving a single anesthetic injection for pain control following shoulder surgery9. Nearly two decades later, Tuominen et al. described an interscalene block technique involving the placement of an indwelling catheter to provide continuous infusion of anesthetic for two to three days of pain relief10. A third modality …