Continuous Interscalene Nerve Block Research Articles

Complication rates and efficacy of single-injection vs. continuous interscalene nerve block: a prospective evaluation following arthroscopic primary rotator cuff repair without a concomitant open procedure

To compare the complications and efficacy of pain relief of the interscalene anesthetic block using either a single-injection (SI) vs. a continuous, indwelling catheter (CIC) for arthroscopic rotator cuff repair surgery. Patients undergoing primary, arthroscopic rotator cuff repair without concomitant open procedure or biceps tenodesis were prospectively enrolled by 4 fellowship-trained sports medicine and shoulder surgeons. Patients received either a SI or CIC preoperatively based on surgeon preference. Patients were contacted by phone to complete a standard questionnaire on postoperative days (PODs) 1, 3, 7, 14, and 28. Patients were asked to rate the efficacy of their subjective pain relief (scale of 0-10), document issues with the catheter, describe analgesic usage, and report pharmacological and medical complications. The primary outcome was measured as complication rate. Postoperative narcotic use, patient satisfaction, and visual analog scale pain scores were measured as secondary outcomes. Seventy patients were enrolled, 33 CIC patients (13 male, 20 female, mean age 61±8 years) and 37 SI patients (20 male, 17 female, mean age 59±10 years). There were significantly more injection/insertion site complications in the CIC group (48%) vs. the SI group (11%, P=.001). The incidence of motor weakness was higher in the CIC group on POD 1 (P=.034), but not at any subsequent time points. On POD 1, CIC patients had a clinically significantly lower pain score compared to SI (3.2 vs. 5.4; P=.020). Similar scores were observed at subsequent time points until POD 28, when CIC again had a lower pain score (0.8 vs. 2.7; P=.005). However, this did not reach clinical significance. All patients in both groups rated a satisfaction of 9 or 10 (scale 0-10) with the anesthesia provided by their nerve block. CIC interscalene nerve blocks had an increased risk for injection site complications and minor complications in the immediate postoperative period when using the CIC for arthroscopic rotator cuff repair without any concomitant open procedures. CIC blocks demonstrated clinically significant superior pain relief on POD 1 but were equal to SI blocks at every time point thereafter. Superior pain relief of CIC at POD 28 was not clinically significant. CIC catheters do not appear to markedly decrease the use of postoperative narcotics. Despite this trend in complication rates and pain scores, all patients in both groups were satisfied with their nerve block.

Comparison of Single Dose with Continuous Infusion of 0.2% Ropivacaine in Interscalene Brachial Plexus Nerve Block for Pain Relief in Rotator Cuff Repair Surgery

Background: Severe postoperative pain is the most common complication after arthroscopic rotator cuff surgery. Peripheral nerve blocks, whether single-shot interscalene block (SSISB) or continuous interscalene nerve block, have consistently demonstrated superior analgesia after upper extremity surgery compared to general anesthesia alone. Aims: The aim of this study was to evaluate the difference in pain relief provided by single shot versus catheterized interscalene block. Materials and Methods: A prospective observational study was conducted in the Department of Orthopedics of Justice K.S.Hegde Charitable Hospital, Mangalore, from January 2020 to June 2021. Thirty patients who were diagnosed of complete rotator cuff tear were included in the study. All of them underwent arthroscopy-assisted single-row rotator cuff repair by the same surgeon under general anesthesia. They were randomly allocated into Groups I and B of 15 each. Patients in Group A received a SSISB and Group II received continuous infusion after the insertion of catheter. The catheter was removed after 24 h of surgery. Both groups followed the same postoperative management protocol. The pain perception assessment was measured using the Visual Analog Scale (VAS) at 6, 24, 48 h after surgery, and at 2nd week postoperative during suture removal. Power was assessed for the wrist (wrist flexion and extension) and for the fingers (finger flexion and abduction) at 6 h, 24 h, 48 h, and after 2 weeks on day 14 when suture removal was done. The results were calculated and tabulated using an independent “t-test” and “Chi-square test.” Results: The patients in Group A had a higher VAS score with a mean of 0.26 ± 0.06 as compared to Group B which showed a mean VAS score of 0 (P = 0.01). Six patients needed analgesia of postoperative day 2. Eight patients of Group B required rescue analgesia on postoperative day 2. Conclusion: Continuous infusion scalene block was noted to be superior to SSISB in the management of postoperative pain postarthroscopy assisted single-row rotator cuff repair.

Modified Continuous Arthroscopy-Guided Suprascapular Nerve Block for Postoperative Pain Control Following Rotator Cuff Repair: Surgical Technique

Arthroscopic rotator cuff repair is one of the most painful surgical procedures; patients complain of pain especially during the first 48 hours postoperatively. Pain management is an essential goal to reduce the demand for analgesic agents and patient discomfort. Various methods have been introduced for arthroscopic rotator cuff repair, including continuous arthroscopy-guided suprascapular nerve blocks (SSNB) and interscalene nerve blocks. However, the aforementioned procedures have shown disadvantages such as catheter mobilization, which may cause injury to the artery, a weak analgesic effect, and Horner syndrome, as well as phrenic nerve paralysis. A modification of the continuous arthroscopy-guided SSNB has been introduced at our hospital: the modified continuous arthroscopy-guided SSNB technique. The aim of this technique is to immobilize the catheter to reduce the chance of injury and minimize postsurgical analgesic needs and patient discomfort.

Single shot interscalene regional anesthesia provides noninferior analgesia and decreased complications compared with an indwelling catheter for arthroscopic and reconstructive shoulder surgery.

There is an abundance of literature comparing the efficacy, safety, and complication rates of regional anesthesia in shoulder surgery. The purpose of this study was to compare analgesia efficacy, and complication rates between single shot and continuous catheters in patients undergoing arthroscopic or reconstructive shoulder surgery in a large cohort. Consecutive patients (n=1888) who underwent shoulder arthroplasty or arthroscopic shoulder surgery and had regional anesthesia were included. Patients had either a single-shot interscalene block (SSIB) or an SSIB with a continuous interscalene nerve block with a catheter (CIB). The decision for SSIB or CIB was selected based on patient risk factors and surgeon preference. Patients received phone calls on postoperative days 1, 2, 7, and 14 to assess for pain levels (numeric rating scale [NRS]) and complications. One hundred sixty patients received SSIB, and 1728 patients received CIB. The postoperative NRS scores at day 1 were also similar. There were 3 complications (2%) in the SSIB group and 172 complications (10%) in the CIB group. Ten patients in the CIB group required emergency department (ED) visits secondary to block complications compared with no ED visits in the SSIB group. In 1888 consecutive patients, SSIB and CIB provided similar pain relief following shoulder surgery. However, patients who received CIB had significantly more complications and ED visits than patients who received SSIB. The potential benefits of longer pain relief may not outweigh the risks of CIB vs. SSIB in common shoulder procedures.

Single-shot liposomal bupivacaine interscalene nerve block provides equivalent pain relief compared to continuous catheter interscalene nerve block in total shoulder arthroplasty

BackgroundThis study compares early postoperative pain control, narcotic usage, and cost in patients undergoing total shoulder arthroplasty with the use of either a single-shot liposomal bupivacaine interscalene nerve block (SS) or a continuous catheter interscalene nerve block (IC). MethodsTwo consecutive cohorts of patients undergoing primary anatomic or reverse total shoulder arthroplasty at different centers with different regional anesthesia protocols (SS vs. IC) were reviewed. Outcomes included pain on a numeric rating scale, narcotic consumption in milligram morphine equivalents, hospital length of stay, duration of nerve blockade, and complications. Block-related supply costs and an estimate of anesthesia professional fees are also reported. ResultsAmong 100 patients evenly divided between SS and IC, the difference in mean numeric rating scale pain scores on postoperative day 0 and 1 was statistically significant in favor of the SS group (1.2 vs. 2.5) but otherwise no difference was noted on postoperative day 2 or 3. There was no difference in milligram morphine equivalents or length of stay. The average duration of the nerve block was 49.8 hours in the SS group, and 84.0 hours in the IC group. SS was less costly than IC regional anesthesia. ConclusionLiposomal bupivacaine used for a single shot interscalene nerve block is as effective as an indwelling catheter for controlling postoperative pain after shoulder arthroplasty. In our system, SS was more cost effective. Level of evidenceLevel Ⅲ; Retrospective Cohort Design; Treatment Study

Nerve Block for Pain Relief During Arthroscopic Rotator Cuff Repair.

Although arthroscopic rotator cuff repair (ARCR) often results in good outcomes, some patients have severe pain postoperatively. This study investigated the efficacy of nerve block for ARCR. This study was retrospective, and consent was obtained from all patients. We divided 50 patients who had undergone ARCR into 4 groups: continuous interscalene nerve block was performed for 11 patients (continuous-injection group), single interscalene nerve block for 10 (single-injection group), suprascapular nerve block for 8 (suprascapular group), and intravenous analgesic administration for 10 (intravenous group). Eleven patients received no nerve block (control group). We evaluated diclofenac sodium and pentazocine dosing, visual analog scale (VAS) scores, and perioperative complications in each group. VAS scoring was done immediately after surgery and 1 and 6 hours and 1, 2, 3, 7, and 14 days postoperatively. The doses of diclofenac sodium and pentazocine did not differ between groups. VAS scores immediately after surgery and at 1 and 6 hours after surgery were significantly lower in the single-injection and continuous-injection groups than in the suprascapular, intravenous, and control groups. VAS score at 1 day postoperatively was significantly lower in the continuous-injection group than in the other groups. One patient in the continuous group reported temporary paralysis of the fingers and drug solution leakage. Interscalene nerve blocks yielded good pain relief for ARCR. Although continuous interscalene nerve block produced continuous pain relief, complications are a concern.

A prospective randomized controlled trial to identify the optimal postoperative pain management in shoulder arthroplasty: liposomal bupivacaine versus continuous interscalene catheter

Shoulder arthroplasty is the fastest growing joint replacement surgery in the United States, and optimal postoperative pain management is critical to optimize outcomes for these surgeries. Liposomal bupivacaine (LB) has gained popularity for its potential to provide extended postoperative pain relief with possibly fewer side effects. The goal of this study was to assess the impact of LB compared with continuous interscalene nerve block (CISB) in terms of postoperative pain control, outpatient pain scores, and patient-reported and functional outcomes after shoulder arthroplasty surgery. A prospective randomized controlled clinical trial compared consecutive patients undergoing shoulder arthroplasty treated with CISB vs. LB with a single bolus interscalene block. The primary outcome measures included pain assessment up to 24 hours after surgery; in addition, all doses and times of narcotics administered during the inpatient stay were recorded. Patient-reported outcome measures for pain, satisfaction, and functional outcomes were recorded postoperatively. A total of 70 of 74 consecutive patients who underwent shoulder arthroplasty were included in the study. The LB group had equivalent narcotic use, pain scores, and time to first narcotic rescue compared with the CISB group within the first 24 hours (P > .05). The LB group had higher American Shoulder and Elbow Surgeons score and Penn Shoulder Score at final follow-up. There was an increased number of complications and cost for the CISB group. This prospective randomized controlled trial demonstrated that LB provides excellent postoperative pain relief for shoulder arthroplasty patients. In addition, LB had fewer complications and lower cost, making it a promising addition to a multimodal pain regimen for shoulder arthroplasty.

The Effect of Fixation Technique on Continuous Interscalene Nerve Block Catheter Success: A Randomized, Double-Blind Trial.

Continuous peripheral nerve blocks offer advantages over single-injection blocks, including extended analgesia and reduction in opioid consumption. These benefits require that the perineural catheter remain intact for the duration of the planned local anesthetic infusion. Mechanical displacement of catheters, leaking, and consequent failure are known complications. The aim of this study was to evaluate continuous perineural catheter tip-to-nerve apposition in vivo over 48 hours comparing 2 different simple fixation strategies. Subjects presenting for a continuous interscalene nerve block were randomized to perineural catheter fixation with 1 of 2 types of adhesive: Dermabond (2-octylcyanoacrylate) or Mastisol (alcohol 23A, gum mastic, storax, and methyl salicylate), covered with a simple transparent dressing. The primary outcome was the evaluation of catheter-to-nerve apposition maintenance over 48 hours via both a blinded ultrasound evaluation of local anesthetic distribution and a blinded clinical assessment. Secondary outcomes included leakage at the catheter site, pain scores, opioid consumption, catheter-to-skin migration at the insertion site, and patient satisfaction. Sixty-six subjects were recruited and randomized to compare adhesive group catheter tip-to-nerve apposition on postoperative day 2 (POD 2). Within the intention-to-treat cohort, a statistically significant decrease of perineural catheter tip-to-nerve apposition in the Mastisol group (64.7%) compared with the Dermabond group (90.6%) on POD 2 (odds ratios [OR] 0.19; 95% confidence interval [CI] 0.05-0.75; P = .012) was observed. Similar results were observed on POD 1 (OR 0.19; 95% CI 0.03-1.38; P = NS) and POD 2 (OR 0.14; 95% CI 0.02-0.97; P = .008) within the as-treated cohort. Catheter leakage (OR 67; 95% CI 7.3-589) and median catheter migration difference at the skin insertion site (2.0 cm; 95% CI 0.5-2.5) were also significantly greater in the Mastisol group than in the Dermabond group from POD 0 to POD 2 (P < .001). Median postoperative opioid consumption difference in morphine equivalents (3.2 mg; 95% CI - 9.0 to 14.2) was not significantly different between the Dermabond and the Mastisol groups through POD 2 (P = .542). Perineural catheter fixation with Dermabond in continuous interscalene nerve block improves maintenance of catheter-to-nerve apposition when compared with Mastisol.

The application of ultrasound, atypical muscle fibers around the roots of the interscalene brachial plexus, and effects on the interscalene nerve block

Objectives The purpose of this study was to estimate the ability of ultrasound (US) to identify the presence of atypical muscle fibers around the roots of the interscalene brachial plexus and their relevance to the performance of continuous interscalene nerve block. Background Ultrasonography is a very effective technique for detecting the altered anatomy within the interscalene area and it helps to avoid complications like intraneural and intravascular injections. Methods This study included 215 patients who received a US-guided interscalene brachial plexus catheter and underwent general anesthesia for shoulder surgery. All patients were examined using US for detection of atypical muscle fibers around the roots of the interscalene brachial plexus and for evaluating pain on the Numerical Rating Scale in the postoperative days. Results The presence of muscle bridges around the roots of the interscalene brachial plexus did not show any statistically significant differences in Numerical Rating Scale pain scores at rest and during movement on the second and third postoperative days. Conclusion US is a very effective technique for detecting the altered anatomy and increases the efficacy of the interscalene nerve block.

Continuous Interscalene Nerve Block Following Adhesive Capsulitis Manipulation

To the Editor: We report on a prospective series of patients who were treated with a 3-day ambulatory perineural local anesthetic infusion in addition to the customary single-injection brachial plexus block for shoulder manipulation, using specific prospectively-defined endpoints. Shoulder adhesive capsulitis may be treated with manipulation under anesthesia to physically break up scar tissue associated with the joint capsule. After manipulation, frequent intensive range-of-motion exercises are critical to prevent recurrence of pathology.1,2 Unfortunately, shoulder motion following manipulation is often painful, greatly limiting adherence to the exercise regimen and resulting in a return of capsular adhesions.3 While treating shoulder pain with continuous interscalene nerve blocks has been studied previously following invasive surgical procedures in the immediate postoperative period,4 their application in non-surgical patients—and any longer-term, post-infusion effects on range-of-motion—remain uninvestigated.

Retained stimulating perineural catheter placed with hydrodissection but without nerve stimulation

To the Editor, We are concerned about the number of recently published reports in your journal regarding difficult-to-remove ambulatory peripheral nerve catheters, all involving the Arrow Stimucath stimulating nerve catheter. We want to share our own recent experience with a retained Stimucath interscalene catheter that was placed without nerve stimulation in an ambulatory patient. Our incident occurred in a 29-yr-old, 64-kg woman who presented for shoulder arthroscopy. She consented to a continuous interscalene nerve block for postoperative analgesia. A posterior approach was used, with a 9-cm, 17-gauge Tuohy needle inserted at the anterior edge of the trapezius muscle. The needle was advanced through the middle scalene muscle under ultrasonographic guidance until the tip of the needle was positioned between the roots of the plexus at approximately the level of C6. Hydrodissection with 5 mL of 5% dextrose solution was then performed to ensure optimal placement. A 19-gauge Arrow Stimucath Catheter (Teleflex Medical, Reading, PA, USA) was inserted without resistance to 1 cm past the tip of the needle. After a negative aspiration, a 5-mL test dose of local anesthetic was injected through the catheter with good spread under ultrasonographic visualization. Finally, the catheter was secured (7 cm depth at the skin) with Dermabond liquid adhesive (Ethicon, Somerville, NJ, USA) and dressed with Tegaderm dressings (3 M Company, St. Paul, MN, USA). After surgery, the patient was called daily for follow-up. On the third postoperative day, a family member was talked through the process of removing the catheter. Unfortunately, traction on the catheter resulted in severe ‘‘electrical shock’’ sensations radiating to the patient’s thumb. The patient was instructed to come to our hospital for evaluation. On arrival, the catheter insertion site was found to be somewhat reddened and tender to direct palpation. Under ultrasonographic guidance, sterile saline was injected. It appeared that the catheter tip was approximately 1 cm lateral to the brachial plexus. A computed tomography scan was obtained, which failed to show any evidence of kinks or knotting and confirmed the catheter to be in an appropriate position adjacent to the expected course of the brachial plexus (Figure). With slow, steady traction and continuous massage of the tissues, the catheter was successfully pulled back 2 cm, but localized tenderness at the catheter insertion site prevented further withdrawal. A surgical consult was next obtained. The patient was taken to an operating room, where general anesthesia was induced with propofol and muscle relaxation obtained with succinylcholine. After muscle relaxation, the catheter was removed, tip intact, with aggressive traction by the surgeon. In the postanesthesia care unit, the patient denied paresthesias or pain in her arm. The patient was kept in the hospital overnight for observation. On follow-up the next day, she reported some residual numbness in her right index finger and thumb, but motor function was normal. The incident was reported to the Food and Drug Administration and the catheter manufacturer; the company could not determine a manufacturingor designrelated cause for the reported event. Two months later, the patient denies any lingering paresthesias and has given written consent to report and publish this case. Abrahams et al., Clendenen et al., Duclas et al., Moran et al., Brenier et al., and Tran et al. have recently published case series or case reports of retained nonkinked or nonknotted Arrow Stimucath stimulating continuous W. K. Rogers, MD (&) R. Jacobs, DO M. J. Donnelly, MD University of Wisconsin School of Medicine and Public Health, Madison, WI, USA e-mail: wrogers@uwhealth.org

Brachial Plexus Entrapment of Interscalene Nerve Catheter after Uncomplicated Ultrasound-Guided Placement

We report on the case of an entrapped interscalene nerve catheter in a 46-year-old male undergoing left shoulder arthroscopic lysis of adhesions for a frozen shoulder. The catheter was placed under ultrasound guidance without any apparent complications. The continuous interscalene nerve block was successfully used as the primary anesthetic and for postoperative pain management. Upon attempted catheter removal, the patient experienced severe pain and paresthesias. Fluoroscopy revealed possible brachial plexus involvement, and surgery was performed to extract the catheter, which had become hooked and entrapped around the C5 nerve root and sheath.

Contralateral local anesthetic spread from an outpatient interscalene catheter

Ambulatory continuous infusions have been associated with improved analgesia and few serious complications. This report describes an unusual case of a patient with a continuous interscalene nerve block who developed a contralateral upper extremity sensory block. The complication did not occur until postoperative day two while the patient was at home. A 56-yr-old woman had a continuous interscalene catheter placed for arthroscopic lysis of adhesions of her shoulder. The insertion needle was initially injected with 0.5% ropivacaine 25 mL (1:400,000 epinephrine), producing a unilateral interscalene block. Postoperatively, the patient was started on a continuous interscalene infusion of 0.2% ropivacaine at 8 mL·hr(-1) via a disposable infusion pump. The next day, the patient had a unilateral brachial plexus block and an associated Horner's syndrome and was discharged home with the infusion. On the morning of the second postoperative day, the patient developed ipsilateral and contralateral Horner's syndrome with associated numbness in both shoulders. The catheter was removed and symptoms resolved four hours later. Ambulatory continuous infusions are typically associated with few serious complications and a favourable safety profile. This case demonstrates that unexpected complications can still occur even after days of normal operation. Based on our previous experience, we believe this to be a rare but potentially serious event that requires awareness by those discharging patients with continuous infusions of local anesthetics.

Infectious Risk of Continuous Peripheral Nerve Blocks

Infectious Risk of Continuous Peripheral Nerve Blocks

Effects of Local Anesthetic Concentration and Dose on Continuous Interscalene Nerve Blocks

Effects of Local Anesthetic Concentration and Dose on Continuous Interscalene Nerve Blocks

Effects of Local Anesthetic Concentration and Dose on Continuous Interscalene Nerve Blocks: A Dual-Center, Randomized, Observer-Masked, Controlled Study

It is currently unknown if the primary determinant of continuous peripheral nerve block effects is simply total drug dose, or whether local anesthetic concentration and/or volume have an influence. We therefore tested the null hypothesis that providing ropivacaine at different concentrations and rates--but at an equal total basal dose--produces similar effects when used in a continuous interscalene nerve block. Preoperatively, an anterolateral interscalene perineural catheter was inserted using the anterolateral approach in patients undergoing moderately painful shoulder surgery. Subjects were randomly assigned to receive a postoperative perineural infusion of either 0.2% ropivacaine (basal 8 mL/h, bolus 4 mL) or 0.4% ropivacaine (basal 4 mL/h, bolus 2 mL) through the second postoperative day. Our primary endpoint was the incidence of an insensate hand/finger during the 24 hours beginning the morning following surgery. The incidence of an insensate hand/finger did not differ between the treatment groups (n = 50) to a statistically significant degree (0.2% ropivacaine, mean [SD] of 0.8 [1.3] times; 0.4% ropivacaine, mean 0.3 [0.6] times; estimated difference = 0.5 episodes, 95% confidence interval, -0.1 to 1.1 episodes; P = .080). However, this is statistically inconclusive given the confidence interval. In contrast, pain (P = .020) and dissatisfaction (P = .011) were greater in patients given 0.4% ropivacaine. For continuous interscalene nerve blocks, given the statistically inconclusive primary endpoint results and design limitations of the current study, further research on this topic is warranted. In contrast, providing a lower concentration of local anesthetic at a higher basal rate provided superior analgesia.

Ambulatory Continuous Interscalene Nerve Blocks Decrease the Time to Discharge Readiness after Total Shoulder Arthroplasty: A Randomized, Triple-masked, Placebo-controlled Study

Ambulatory Continuous Interscalene Nerve Blocks Decrease the Time to Discharge Readiness after Total Shoulder Arthroplasty: A Randomized, Triple-masked, Placebo-controlled Study

Ambulatory Continuous Interscalene Nerve Blocks Decrease the Time to Discharge Readiness after Total Shoulder Arthroplasty

A continuous interscalene nerve block (CISB) may be used to provide analgesia after shoulder arthroplasty. Therefore, inpatient stays may be shortened if CISB (1) provides adequate analgesia without intravenous opioids and (2) improves shoulder mobilization. This study investigated the relationship between ambulatory CISB and the time to reach three discharge criteria after shoulder arthroplasty. Preoperatively, patients received a CISB. All patients received a perineural 0.2% ropivacaine infusion from surgery until 06:00 the following morning, at which time they were randomly assigned either to continue perineural ropivacaine or to switch to normal saline. The primary endpoint was the time from the end of surgery until three discharge criteria were attained (adequate analgesia, independence from intravenous analgesics, and tolerance to 50% of shoulder motion targets). Patients were discharged home as early as the afternoon after surgery with their CISB using a portable infusion pump. Patients receiving perineural ropivacaine (n = 16) attained all three discharge criteria in a median (10th-90th percentiles) of 21 (16-41) h, compared with 51 (37-90) h for those receiving perineural normal saline (n = 13, P < 0.001). Unlike patients receiving perineural ropivacaine, patients receiving perineural normal saline often required intravenous morphine, but still experienced a higher degree of pain and tolerated less external rotation. An ambulatory CISB considerably decreases the time until readiness for discharge after shoulder arthroplasty, primarily by providing potent analgesia that permits greater passive shoulder movement and the avoidance of intravenous opioids. Additional research is required to define the appropriate subset of patients and assess the incidence of complications associated with earlier discharge.

Joint Range of Motion After Total Shoulder Arthroplasty With and Without a Continuous Interscalene Nerve Block

Joint Range of Motion After Total Shoulder Arthroplasty With and Without a Continuous Interscalene Nerve Block

Joint Range of Motion After Total Shoulder Arthroplasty With and Without a Continuous Interscalene Nerve Block: A Retrospective, Case-Control Study

Although a continuous interscalene nerve block (CISB) has been shown to provide potent analgesia after major shoulder surgery, its potential effects on postoperative rehabilitation remain uninvestigated. Therefore, this retrospective case-control study was undertaken to determine the association between CISB and joint range-of-motion after total shoulder arthroplasty (TSA). The medical records for patients who underwent TSA at our institution in the previous 3 years were examined. Each patient with a CISB (cases) was matched with a patient without a CISB (controls) for the following variables: age, gender, and TSA type (primary v revision). Data collected included maximum shoulder elevation and external rotation (primary endpoints), along with pre- and postoperative pain scores. Of 134 charts reviewed, 25 cases were matched with an equal number of controls. On postoperative day 1, patients with or without a CISB achieved a median (5th-95th percentiles) of 85% (51-100) and 33% (11-56) of their surgeon-defined goal for elevation (P = .048), respectively, and attained 100% (33-100) and 17% (-81-68) for external rotation (P < .001), respectively. The median numeric rating pain score (NRS) during shoulder movement for patients with CISB was 2.0 (0.0-8.7) versus 8.5 (1.8-10.0) for patients without CISB (P < .001). Least, median, and highest resting NRS for the 24 hours after surgery were 0.0 (0.0-5.8), 1.0 (0.0-6.4), and 3.0 (0.0-9.0) for patients with CISB, respectively, versus 2.0 (0.0-7.7), 6.0 (0.3-9.6), and 8.0 (0.0-10.0) for patients without CISB (P = .030, P < .001, and P < .001 between groups, respectively). The day after TSA, a CISB is associated with increased shoulder range of motion, most likely resulting from the potent analgesia these nerve blocks provide.