The Continued Search for the Perfect Analgesic

Abstract

When queried about perioperative concerns, patients have rated postoperative pain as being of greater concern than making a full surgical recovery1. A study of >10,000 ambulatory surgery patients demonstrated that orthopaedic patients had the highest incidence of severe postoperative pain2. Therefore, finding safe, effective, and efficient means of perioperative pain control is of paramount importance to both anesthesiologists and orthopaedic surgeons. In the current study, Singh et al. examined the use of ultrasound-guided interscalene brachial plexus block in patients undergoing arthroscopic shoulder surgery. Their approach was ambitious; they prospectively followed 1319 patients with the goal of evaluating ultrasound-guided interscalene block in terms of safety, efficacy, and patient satisfaction. The most striking strengths of this study are the large patient cohort and the exclusive use of ultrasound guidance, thus making this the largest prospective study to date on the use of this modality for interscalene block. In the competitive era of “customer service,” patient satisfaction is a valuable addition to the study design. The authors concluded that 99% of patients were either very satisfied or satisfied with the interscalene block, but, probably more telling, 98% of patients who were queried stated that they would undergo an interscalene block again. As all of the blocks had likely worn off at the time of the follow-up telephone interview and the patients were facing the painful truth of surgery “post-block,” this is an impressively high percentage. The authors’ finding of 99.6% efficacy of ultrasound-guided interscalene block remains somewhat unclear. Their definition of efficacy is block failure; that is, inadequate sensory blockade after thirty minutes of block placement. Unfortunately, these metrics are never defined further. Were all nerves of …