Patients Undergoing Shoulder Surgery Research Articles

Osteoporosis Management for Shoulder Surgeons.

The aim of this review is to aggregate currently available literature as it pertains to treating surgical shoulder pathology in patients with osteoporosis. Emerging data surrounding perioperative use of anti-osteoporosis medications for patients undergoing shoulder surgery have not shown definitively favorable or unfavorable outcomes. Similar evaluations in animal studies have shown promising results as a biologic augment to tendon and bone healing, especially with newer, anabolic agents. The mainstay of bone health management remains pre-operative evaluation, using opportunistic radiographic and CT based validated measurements, along with optimization of risk factors. Surgical techniques continue to incorporate implants that perform well in osteopenic bone. Promising pre-clinical studies have identified anabolic anti-osteoporosis medications as viable biologic augments to shoulder surgery, which has not been borne out in any clinical studies at this time.

Cryo-Pneumatic Compression Results in a Significant Decrease in Opioid Consumption After Shoulder Surgery: A Multicenter Randomized Controlled Trial.

The management of pain after shoulder surgery typically includes the use of cryotherapy and the prescription of opioid analgesics. Much focus has been placed lately on the opioid epidemic, which in part is fueled by excessive prescription of opioid medication. Previous studies have found a combination of cryotherapy and compression effective at reducing analgesic consumption and increasing recovery in patients undergoing knee and spine surgery; however, efficacy in patients undergoing shoulder surgery has not been evaluated. To evaluate the effectiveness of a cryo-pneumatic compression device on postoperative shoulder pain, narcotic use, and quality of life when compared with standard care cryotherapy. Randomized controlled trial; Level of evidence, 2. In total, 200 patients older than 18 years scheduled for unilateral shoulder surgery were enrolled. Patients were randomized to receive either postoperative cryo-pneumatic compression or standard care. The intervention group received a cryo-pneumatic device, while the standard care group received the treating surgeon's preferred method of postoperative care, including standard cryotherapy. Narcotic use was evaluated by the number of oral morphine milligram equivalents consumed during the postoperative period, as well as the time to cessation of narcotic use. Patient-reported outcome measures consisted of a numeric rating scale pain score, 36-item Short Form Survey, patient experience assessed using the net promoter score, and adverse events. Outcomes were evaluated at 2, 6, and 12 weeks postoperatively. Patients receiving cryo-pneumatic compression reported a significant decrease in opioid consumption when compared with standard care (oral morphine milligram equivalents median, 56.1 vs 112; P = .02468). A significant increase in self-reported function was seen in the cryo-pneumatic compression group at 2 weeks when compared with standard care (mean, 61.2 vs 54.2; P = .0412). In patients undergoing unilateral shoulder surgery, the use of cryotherapy with pneumatic compression, when compared with standard care, resulted in significantly decreased opioid consumption as well as increased function at 2 weeks. NCT04185064 (ClinicalTrials.gov identifier).

Correlation between the optimal screening for prediction of referral and outcome yellow flag tool and patient-reported legacy outcome measures in patients undergoing shoulder surgery

BackgroundThe Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) Tool is a 10-item multidimensional screening tool utilized to evaluate pain-related psychological traits in individuals with musculoskeletal pain conditions. The validity of postoperatively collected OSPRO-YF is unclear. This study sought to assess validity of the OSPRO-YF by comparing it to PRO scores in both pre- and postoperative settings. HypothesisThe authors hypothesized that OSPRO-YF overall score would correlate with shoulder and global function PROs at pre- and postoperative timepoints. MethodsA review of 101 patients undergoing shoulder surgery by one sports medicine orthopedic surgeon at a large academic institution was conducted. 90 and 54 patients had complete pre- and postoperative PRO responses. OSPRO-YF, American Shoulder and Elbow Surgeons Evaluation Form (ASES), and Patient-Reported Outcomes Measurement Information System Computer Adaptive Test (PROMIS-CAT) were routinely administered before and after surgery at the senior author’s clinic visits. Concurrent validity of OSPRO-YF at either timepoint was assessed by comparing scores with PROs cross-sectionally using Pearson correlations and multiple comparison corrections. ResultsPreoperatively, higher OSPRO-YF total score was associated with greater concurrent PROMIS-CAT Pain Interference (r=0.43; p<0.01) and Depression (r=0.36; p=0.05) and lower ASES (r=-0.34; p<0.01). Higher postoperative OSPRO-YF was also associated with greater concurrent PROMIS-CAT Pain Interference (r=0.43; p<0.01) and Depression (r=0.36; p<0.01) and lower ASES (r=-0.34; p=0.01). ASES had strong correlation with SANE and Pain scores at both pre- and postoperative timepoints. SANE was not significantly associated with OSPRO-YF total score or number of YFs at either timepoints. ConclusionThe study findings support the clinical validity of the 10-item OSPRO-YF tool when administered before or after shoulder surgery. For patients exhibiting suboptimal recovery or those identified as high risk at initial screening, assessment of pain-related psychological distress postoperatively may be particularly beneficial in guiding rehabilitation.

Correlation Between Patient-Reported and Clinician-Measured Shoulder Range of Motion in Patients Undergoing Shoulder Surgery.

There has been increasing interest in remote measures of patients' health, both in the clinical and research settings. This study sought to evaluate correlations between patient-reported and clinician-measured (CM) shoulder range of motion (ROM). ROM measures including elevation, abduction, and internal rotation were recorded by a patient-reported picture-based survey and clinician measurement during each patient visit. A total of 13,842 visits over a 16-year period met inclusion criteria. Spearman correlation was performed to determine the correlation between patient-reported and CM elevation, abduction, and internal rotation. A subgroup analysis was conducted to evaluate motion in patients who underwent arthroplasty and arthroscopy. Patients were 52.4% male with a median age of 67 years (range, 18 to 96). PR and CM shoulder ROM were gathered at 13,842 patient visits. Strong correlations between PR and CM elevation (r = 0.70) and internal rotation (r = 0.66) were found, as well as a moderate correlation between PR and CM abduction (r = 0.59). Strong correlations were found between all three PR and CM measures of motion in the arthroplasty subgroup (elevation r = 0.74, abduction r = 0.63, and internal rotation r = 0.64). There is a strong correlation between patient-reported and CM shoulder elevation and internal rotation, as well as a moderate correlation between PR and CM abduction. This allows for a method of assessing patient motion without requiring an in-person visit. Level III Retrospective Cohort Study.

Assessing changes in regional cerebral hemodynamics in adults with a high-density full-head coverage time-resolved near-infrared spectroscopy device.

Cerebral oximeters have the potential to detect abnormal cerebral blood oxygenation to allow for early intervention. However, current commercial systems have two major limitations: (1)spatial coverage of only the frontal region, assuming that surgery-related hemodynamic effects are global and (2)susceptibility to extracerebral signal contamination inherent to continuous-wave near-infrared spectroscopy (NIRS). This work aimed to assess the feasibility of a high-density, time-resolved (tr) NIRS device (Kernel Flow) to monitor regional oxygenation changes across the cerebral cortex during surgery. The Flow system was assessed using two protocols. First, digital carotid compression was applied to healthy volunteers to cause a rapid oxygenation decrease across the ipsilateral hemisphere without affecting the contralateral side. Next, the system was used on patients undergoing shoulder surgery to provide continuous monitoring of cerebral oxygenation. In both protocols, the improved depth sensitivity of trNIRS was investigated by applying moment analysis. A dynamic wavelet filtering approach was also developed to remove observed temperature-induced signal drifts. In the first protocol ( years; five females, five males), hair significantly impacted regional sensitivity; however, the enhanced depth sensitivity of trNIRS was able to separate brain and scalp responses in the frontal region. Regional sensitivity was improved in the clinical study given the age-related reduction in hair density of the patients ( years; 14 females, 13 males). In five patients who received phenylephrine to treat hypotension, different scalp and brain oxygenation responses were apparent, although no regional differences were observed. The Kernel Flow has promise as an intraoperative neuromonitoring device. Although regional sensitivity was affected by hair color and density, enhanced depth sensitivity of trNIRS was able to resolve differences in scalp and brain oxygenation responses in both protocols.

Opioid use and disposal at 2 weeks post-surgery: Brief communication regarding excess opioids and disposal habits.

To measure the number of unused prescription opioids and disposal habits of patients following orthopedic shoulder surgery. A prospective observational study. Academic orthopedic sports medicine department. Sixty-seven patients undergoing shoulder surgery. Nine-question opioid use questionnaire. Responses to an opioid use questionnaire were collected at 2 weeks post-surgery. Outcomes of interest included the amount of initial opioid prescription used and the disposal of excess opioids. Sixty-seven patients completed the opioid use questionnaire. Forty-six (68.7 percent) patients reported having excess opioids at 2 weeks. Of the 46 patients with excess opioids, 57 percent disposed of the excess, and 43 percent planned to keep their opioids. Two-thirds of the patients reported having excess opioids, highlighting the issue of an overabundance of unused prescription opioids in America. Utilization of opioid-free pain management strategies and drug disposal kits should be explored to reduce the number of unused and improperly disposed opioids.

Osteoporosis in the setting of rotator cuff repair: A narrative review

Osteoporosis and osteopenia are frequently found in patients undergoing shoulder surgery, especially rotator cuff repair, and it is anticipated that this link will become more common as more elderly people have operations on their shoulders. For orthopedic surgical candidates who are at high risk, preoperative screening may identify those who might benefit from early intervention and prevent any associated adverse events. The major complications include repair failure and revision surgery. Antiresorptive medication preoperatively has shown good results in vivo. However, when used in the clinical setting, the efficacy remains controversial. Surgical management may include repair augmentation and placing the anchors in the posteromedial part of the greater tuberosity. Level of evidence IV.

Chronological changes in the rate of surgical field contamination in the shoulder joint

BackgroundIn shoulder surgery, low-virulence bacteria such as Cutibacterium acnes and coagulase-negative staphylococci can cause postoperative infection. However, the degree of sterility during surgery after disinfection is not known, and the efficacy of double skin preparation for such bacteria is unclear. This study aimed to evaluate chronological changes in the surgical field contamination rate in the shoulder joint and to compare single and double skin preparation. MethodsIn total, 126 shoulders in 121 patients undergoing shoulder surgery (64 men, 62 women; mean age 64 years) were enrolled. Patients were divided into two groups: single skin preparation, where the site was painted with 10% povidone iodine, and double skin preparation, where the site was treated with 1% chlorhexidine gluconate/83% isopropyl alcohol and painted 10% povidone iodine. Swab samples from the axillary and proximal areas in the surgical field were collected chronologically before starting surgery and at 30, 60, and 120 min after starting surgery (MAS). The contamination rate of each sample was compared and detected species were evaluated. ResultsThe contamination rate for the axillary area was 48.4%, 85.9%, 95.3%, and 97.1% in the single-preparation group and 32.3%, 72.6%, 87.1%, and 91.2% in the double-preparation group before starting surgery and 30, 60, and 120 MAS, respectively, and that the proximal area was 12.5%, 26.6%, 29.7%, and 35.3% in the single-preparation group and 16.1%, 19.4%, 27.4%, and 38.2% in the double-preparation group, respectively. Significant differences were not seen between the groups by area or time point. Most detected species were Cutibacterium acnes and coagulase-negative staphylococci. ConclusionsThe incidence of surgical field contamination in shoulder joint was high from immediately after starting surgery. In the axillary area, the contamination rates exceeded 70% from 30 MAS in both groups. Measures against infection should be instituted considering these findings when performing shoulder surgery.

Risk factors of liposomal bupivacaine failure in managing postoperative pain following shoulder surgery

BackgroundAmidst a national opioid crisis, increased focus has been placed on reducing opioid consumption. Novel multimodal pain protocols including the use of liposomal bupivacaine (LB) have shown success in minimizing opioid usage after orthopedic surgery. There is disputing evidence of the effectiveness of LB use in shoulder surgery and the purpose of our study was to analyze the risk factors and determinants of LB failure for postoperative pain control after orthopedic shoulder surgeries. MethodsA retrospective review of 121 patients undergoing shoulder surgery treated by 2 fellowship-trained shoulder surgeons at a single institution was performed from 2018-2020. All patients received a standardized multimodal pain management protocol that included an LB interscalene block. Local infiltration of LB was also administered at closure. Visual analog scales (VASs) were administered at 24, 48, 72 hours, and 7 days postoperatively. LB failure was defined as visual analog scale score >7 any time within the 7-day postoperative period. Twenty-one patients were included in the liposomal bupivacaine failure (LBF) group and 100 in the liposomal bupivacaine success (LBS) group. Patient demographics, pain scores, and opioid consumption were compared between groups. ResultsBaseline characteristics were comparable, except the LBF cohort had a greater proportion of females (P = .03). The LBF group had 20% of patients with a history of chronic opioid use compared to none in the LBS group (P = .003). Logistic regression showed strong and independent associations between failure of LB and performing surgeon, chronic opioid use, gender, and history of prior surgery. Patients in the LBF group had an average of 20 total morphine equivalents 7-14 days following surgery compared to 0 total morphine equivalents (P = .002) in the LBS group, and an average of 2.9 opioid prescriptions within the first 6 months compared to 1.7 in the LBS group (P = .028). ConclusionPerforming surgeon, gender, history of opioid use, and prior surgeries were all identified as strong, independent predictor variables of LB failure. In this study, performing surgeon is likely indicative of the impact of differences in patient education on postoperative pain expectations and alternate treatments. We recommend that surgeons incorporate further preoperative patient education, and to take into account, the specific risk factors when deciding to incorporate LB into their multimodal postoperative pain management plan for patients undergoing shoulder surgery.

A High Rate of Return to Running Is Seen After Both Arthroscopic and Open Shoulder Surgery

To determine the percentage of patients who report the ability to run 1 mile at various time points after arthroscopic and open shoulder surgery. We performed a retrospective review of prospectively collected data for all active-duty military patients aged 18 to 45 years who underwent shoulder surgery at a single institution over a 2-year period. The rehabilitation protocol discouraged running before 3 months, but all patients were able to return to unrestricted running at 3 months postoperatively. Patients were excluded if they lacked 1-year follow-up data. Parameters collected included demographic information and validated patient-reported outcome measures at the preoperative and short-term postoperative visits, as well as patients' ability to run at least 1 mile postoperatively. A total of 126patients were identified who underwent shoulder surgery with return-to-running data. Compared with baseline, significant improvements in patient-reported outcomes were shown at 1 and 2 years postoperatively (P= .001). The percentage of patients reporting the ability to run 1 mile postoperatively was 59% at 3 months, 74% at 4.5 months, 79% at 6 months, 83% at 12 months, and 91% at 24 months. There was no significant difference in patients undergoing shoulder surgery for instability versus non-instability diagnoses or in patients undergoing open versus arthroscopic anterior stabilization. All 11 patients unable to return to running at final follow-up had chronic lower-extremity diagnoses limiting their running ability. Young military athletes undergoing arthroscopic and open shoulder surgery have a high rate of early return to running. Approximately 60% of patients report the ability to run 1 mile at 3 months postoperatively, and three-quarters of patients do so at 4.5 months. Age, sex, military occupation, underlying diagnosis or type of surgery did not influence the rate of return to running after shoulder surgery. Level IV, therapeutic case series.

Increased Actual Sling Wear is Associated with Better Early Patient-Reported and Image-Based Outcomes After Shoulder Surgery.

Prior studies have failed to show differences in functional outcomes for patient-reported sling use after rotator cuff repair. Temperature sensing devices are used to more accurately measure brace adherence. The purposes of this study were to quantify actual sling adherence and its predictors, and to establish whether increased sling adherence is associated with improved functional and image-based outcomes. We performed a prospective cohort study of 65 patients undergoing shoulder surgery requiring at least four weeks of postoperative sling use. Temperature-sensing devices were implanted in the slings to monitor sling adherence. Patient-reported sling adherence was determined from a questionnaire. Patients were considered 80% adherent if they wore the sling for 16 hours per day (112 hours per week) when 20 hours per day was prescribed. The primary outcomes were the patient-reported and actual sling adherence, patient-reported outcomes (ASES and VAS pain scores) within 12-months postoperatively, and image-based failure based on ultrasound or x-ray at 6-weeks and 1-year postoperatively. Patient-reported sling adherence was highly sensitive (82.8%), poorly specific (28.6%), had low accuracy (53.1%), and was weakly correlated with actual sling adherence (r = 0.32; P = 0.009). In a multivariable logistic regression analysis, males were 91% less likely than females to be adherent with sling use (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.02 to 0.42; P = 0.002). Additionally, obese and morbidly obese patients were 88% (95% CI, 0.02-0.84; P = 0.033) and 98% (95% CI, 0.002-0.27; P = 0.003), respectively, less likely to adhere with sling wear postoperatively than non-obese patients. After controlling for surgical procedure, VAS pain scores were significantly better at 6 weeks (β = -1.47; 95% CI, -2.88 to -0.05; P = 0.04) and 3 months (β = -1.68; 95% CI, -3.28 to -0.08; P = 0.04) if patients adhered with sling wear. A receiver operating characteristic curve showed that 13.6 hours and 15.4 hours of daily sling wear optimizes image-based outcomes at 6-weeks (0% versus 16% failure; P = 0.01) and 1-year (3% versus 28% failure; P = 0.008) postoperatively, respectively. The results of this study demonstrate that patient-reported sling adherence is unreliable, adherence can be predicted by female sex and lower BMI, and increased sling adherence is associated with improved early pain scores and image-based outcomes. These data can help inform future studies utilizing postoperative sling protocols, as patient-reported sling adherence is not an accurate method to assess sling use.

Post-operative Urinary Dysfunction Following Shoulder Surgery: Rates and Risk Factors.

Post-operative urinary retention (POUR) and dysfunction are recognized complications following orthopaedic surgery. Recent literature has focused on urinary retention and its associated complications following hip and knee reconstruction and lower extremity surgery. There is a paucity of literature focusing on POUR and shoulder surgery. The purpose of this study is to describe the rates of urinary dysfunction in patients undergoing shoulder surgery as well as the associated risk factors. This was a single institution, prospective cohort study. Eligibility criteria included patients older than 50 years of age undergoing open or arthroscopic shoulder surgery. The primary outcome was the American Urological Association (AUA) symptom score (7 questions total scored 0-5, total 35 points max) administered before and after surgery. Higher scores reflect worse urinary dysfunction. Intra-operative data such as type of surgery, type of anesthesia, use of anticholinergics, peripheral nerve block, length of case, and amount of intravenous fluids were collected. Of 194 patients, the mean age was 61.4 years (Standard Deviation (S.D.) = 13.0)) and the average BMI was 29.2 (S.D. = 5.6). The sample was 35.6% female. Overall, 46.4% reported worse AUA scores post-operatively within the first 3 to 5 days, including 4.1% of which were clinically defined as "moderately worse" (>5 point worse) or "much worse" (>11 points worse). Worse preoperative AUA scores correlated with worse postop AUA score on linear regression analysis (r=0.883, P<0.0001). Males with a history of BPH showed a statistically significant positive association with worsening urinary dysfunction postoperatively (P=0.039). Four patients (2.1%) required postoperative catheterization. A significantly higher percentage of patients with preoperative AUA scores of ≥11 experienced worsening of urinary function post-operatively (P=0.04). Worsening of urinary function following shoulder surgery is common. The AUA score may be used to identify at-risk patients and to track changes in urinary function post-operatively. Men with a diagnosis of BPH are at particularly high risk. Further investigation is needed to elucidate the impact of urinary dysfunction on patient outcomes, satisfaction, and cost as well as the role of prophylactic medications.

Rate and time to return to shooting following arthroscopic and open shoulder surgery

There is limited information on return to shooting following shoulder surgery. The purpose of this study is to determine the rate and timing for resuming shooting a rifle following shoulder surgery. We performed a retrospective review of prospectively collected data. The study included patients undergoing arthroscopic and open shoulder stabilization for unidirectional shoulder instability, and arthroscopic surgery for rotator cuff tears, SLAP lesions, biceps tendinopathy, and acromioclavicular pathology. Data collected included the laterality of surgery, shooting dominance, and patient-reported outcome measures at the preoperative and postoperative visits. Starting at the 4.5-month clinic visit, patients were asked if they could shoot a military rifle. One hundred patients were identified with arthroscopic and open shoulder surgery with a mean age of 30 years (range, 18-45) and a mean follow-up of 24 months (range, 12-32). The cohort consisted of patients undergoing arthroscopic Bankart repair (n=23), arthroscopic posterior labral repair (n=18), open Latarjet (n=16), mini-open subpectoral biceps tenodesis (OBT) (n=25), OBT with open distal clavicle resection (DCR) (n=10), open DCR (n=4), and arthroscopic rotator cuff repair with concomitant OBT (n=4). Significant improvement in SSV, VAS, ASES, and WOSI was shown at 1-year postoperative, SSV 85, VAS 2, ASES 85, WOSI 239, P=.001. The percentage of patients reporting the ability to shoot a military rifle postoperatively were 47%, 63%, 85%, and 94% at 4.5 months, 6 months, 1 year, and 2 years, respectively. At 4.5 months postoperatively, patients who underwent surgery ipsilateral to their shooting dominance (n=59) had a rate of return to shooting (33%) versus shoulder surgery on the contralateral side of shooting dominance (n=41) (60%), P=.04. However, there was no significant difference in the groups at 6 months and 1 year. Additionally, there was a significant difference in the rate of return to shooting at 6 months in patients undergoing arthroscopic posterior labral repair versus the remainder of the cohort (posterior instability (33%) vs. (69%), P=.016), and a significant difference between posterior shoulder stabilization and anterior shoulder stabilization (70%), P=.03. Patients undergoing arthroscopic and open shoulder surgery have a high rate of return to shooting. Approximately 60% of patients resume shooting at 6 months postoperatively and 85% return at 1 year. Patients undergoing shoulder surgery on the contralateral side of their shooting dominance return to shooting significantly faster than those with shoulder surgery ipsilateral to their shooting dominance. Additionally, those undergoing arthroscopic posterior shoulder stabilization return to shooting at a slower rate than anterior stabilization surgery.

Telehealth Visits After Shoulder Surgery: Higher Patient Satisfaction and Lower Costs.

Introduction:Studies comparing the cost of in-person and virtual care are lacking. The goal of this study was threefold (1) to compare the cost of telemedicine visits with in-person clinic visits after common shoulder surgeries, (2) to measure the safety, and (3) to evaluate patient experience with telemedicine visits.Methods:The In-Person Visit cohort (N = 25) and the telemedicine cohort (Virtual Visit cohort, N = 24) were selected from patients undergoing routine follow-up of common shoulder procedures. Time-driven activity-based costing was used to determine costs associated with each episode of care. Patient complications, satisfaction, convenience, and technical difficulties associated with telehealth were recorded.Results:The average Virtual Visit was 54.1% less costly and 87.8% shorter than the In-Person Visit ($49 versus $107 per patient, 8.6 versus 70.1 minutes per patient, P < 0.01, respectively). One complication was missed in the Virtual Visit cohort, later captured by an in-person visit. All patients in the Virtual Visit cohort reported that the virtual visit was safe and convenient and showed high levels of satisfaction.Discussion:Virtual visits for postoperative care of patients undergoing shoulder surgery are associated with decreased costs and high ratings of convenience and satisfaction. Postoperative complications may be more challenging to diagnose virtually.

Superior Block Length and Reduced Opioid Use with Dexmedetomidine and Dexamethasone regional block versus plain Ropivacaine: a retrospective trial.

The purpose of this study is to determine if using a combination of dexamethasone and dexmedetomidine (Dex-Dex) in a single-shot perineural local anesthestic provides an increased duration of pain relief and reduced consumption of opioids for patients undergoing shoulder surgery. This is a retrospective trial of adult patients without major comorbidities undergoing elective, upper arm orthopedic procedures with regional nerve block for post-operative analgesia. Patients underwent nerve block with either 0.5% ropivacaine or 0.2% ropivacaine with 5mg dexamethasone and 25mg dexmedetomidine ("dex-dex"). Patients were assessed in 1-week intervals for two weeks for duration of block analgesia, pain scores, and opioid use. 31 patients were included, 12 controls and 19 in the dex-dex group. These patients underwent one of arthroscopic rotator cuff repair, reverse total shoulder repair or repair of humerus fractures. Dex-dex blocks provided significantly longer analgesia (median block time 3.5 versus 1.5 days, p<0.0001), significantly better analgesia (mean NRS 2.32 versus 8.58 on post-operative day 1, p<0.0001), and significantly reduced opioid requirements (108.16mg vs 275.63mg in MME, p<0.0001). One patient experienced transient hypotension and prolonged paresthesia in the dex-dex group. Preoperative single-shot interscalene nerve blocks with preservative-free dexamethasone and dexmedetomidine added as adjuvants to ropivicaine provide approximately two additional days of benefit versus ropivicaine alone. Additionally, postoperative opioid consumption is reduced.

PROMIS Depression and Anxiety in shoulder surgery patients.

The purpose of this study was to assess the prevalence of depression and anxiety symptoms in patients undergoing shoulder surgery using the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety computer adaptive tests, and to determine the factors associated with more severe symptoms. Additionally, we sought to determine whether PROMIS Depression and Anxiety were associated with functional outcomes after shoulder surgery. This was a retrospective analysis of 293 patients from an urban population who underwent elective shoulder surgery from 2015 to 2018. Survey questionnaires included preoperative and two-year postoperative data. Bivariate analysis was used to identify associations and multivariable analysis was used to control for confounding variables. Mean two-year PROMIS Depression and Anxiety scores significantly improved from preoperative scores, with a greater improvement observed in PROMIS Anxiety. Worse PROMIS Depression and Anxiety scores were also significantly correlated with worse PROMIS Physical Function (PF) and American Shoulder and Elbow Surgeons scores (ASES). After controlling for confounding variables, worse PROMIS Depression was an independent predictor of worse PROMIS PF, while worse PROMIS Anxiety was an independent predictor of worse PROMIS PF and ASES scores. Mean two-year PROMIS Depression and Anxiety scores improved after elective shoulder surgery and several patient characteristics were associated with these scores. Worse functional outcomes were associated with worse PROMIS Depression and Anxiety; however, more severe two-year PROMIS Anxiety was the strongest predictor of worse functional outcomes. Cite this article: Bone Joint J2022;104-B(4):479-485.

Evolution of Anesthetic Techniques for Shoulder Surgery: A Narrative Review

Shoulder surgery has radically evolved within the last 70 years, from a marginal orthopedic sub-specialty to an area of great research and advancement; consequently, anesthetic techniques have undergone important development. In fact, a wide variety of anesthetic strategies have emerged, to provide anesthesia and post-operative analgesia: general anesthesia (GA), regional anesthesia (RA), or combined GA and RA. A literature review on online databases was carried out about the different anesthetic approaches for shoulder surgery and their evolution through the years, taking in consideration papers from 1929 to 2021. A comprehensive preoperative assessment of patients undergoing shoulder surgery allows to identify and modify potential risk factors and complications of general anesthesia. Moreover, the use of ultrasound-guided regional blocks could improve the effectiveness of these techniques and bring better postoperative outcomes. Anesthetic management for shoulder surgery has progressed drastically during the last century. More studies are needed to finally standardize anesthetic techniques for specific procedure.

Comparison of propofol and ketofol for sedation in patients undergoing shoulder surgery with interscalene and suprascapular nerve blocks

Introduction and Purpose: We compared propofol and ketofol for sedation in patients who underwent shoulder arthroscopy under anesthesia with interscalene and suprascapular blocks. We evaluated both of agents the intraoperative hemodynamic effects, sedation efficiency, postoperative recovery times and the time to discharge to the service. We aimed to achieve an effective sedation with stable hemodynamics, resulting in rapid recovery with early onset.&#x0D; Methodology: The study was carried out prospectively in a double-blind randomized study on ASA I and II patients aged 18-65, total of 42 shoulder surgeries planned. Anesthesia was provided to the patients by performing interscalene and suprascapular nerve block with USG. Group 1 (Propofol group), 1 mg/kg propofol iv, in Group 2 (Ketofol group), a mixture of ketamine-propofol was prepared in a 1:1 ratio, 1 mg / kg ketofol iv was administered. Processing was started in both groups when Ramsey Sedation Scale (RSS) was 3. SBP, DBP, MBP, heart rate, O2 saturation, RSS, Faces scale were recorded throughout the case. The patients with an Aldrete score of 9 were discharged and sent to the service.&#x0D; Results: A total of 42 patients undergoing planned shoulder surgeries were enrolled. No statistically significant was determined between the groups in respect of demographic data (age, gender, height, weight, ASA), operating time and postoperative length of stay in hospital. More patients required esmolol in the ketofol group compared to propofol group; 15 (71.4%) vs. 7 (33%) patients (p &lt; 0.05). Significant higher mean values of hemodynamic findings in the ketofol group were noted; SBP at 55 min, DBP at 60 min, MBP at 60 min and MBP on discharge (p &lt; 0.05). In the absence of esmolol, the pulse measurements at 0, 1, 3, 25, and 30 min were determined to be statistically significantly higher in the ketofol group than the propofol group (p &lt; 0.05). The mean values of the SpO2 measurements were significantly lower in the ketofol group (p &lt; 0.05). No statistically significant difference was determined in respect of the postoperative modified Aldrete Scores (MAS) at any of the time points (p &gt; 0.05).&#x0D; Conclusion: While a deeper and higher quality sedation was provided with ketofol, we achieved rapid onset and short-acting sedation with propofol. Both agents have different superior properties and can be used safely for sedation.&#x0D; Key words: Brachial plexus block, ketofol, shoulder arthroscopy, propofol, sedation&#x0D; Citation: Akcaalan Y, Sahap M, Gulec H, Horasanli E, Ugurlu M, Akcaalan S. Comparison of propofol and ketofol for sedation in patients undergoing shoulder surgery with interscalene and suprascapular nerve blocks. Anaesth. pain intensive care 2022;26(1):102-109.&#x0D; DOI: 10.35975/apic.v26i1.1775&#x0D; Received: September 24, 2021, Reviewed: October 18, 2021, Accepted: Nov 09, 2021

Effect of superior trunk block on diaphragm function and respiratory parameters after shoulder surgery

BackgroundThe interscalene brachial plexus block has been used effectively for intraoperative and postoperative analgesia in patients undergoing shoulder surgery, but it is associated with high rates of diaphragmatic dysfunction. Performing...

The role of preoperative opioid use in shoulder surgery-A systematic review.

Emerging evidence suggests preoperative opioid use may increase the risk of negative outcomes following orthopedic procedures. This systematic review evaluated the impact of preoperative opioid use in patients undergoing shoulder surgery with respect to preoperative clinical outcomes, postoperative complications, and postoperative dependence on opioids. EMBASE, MEDLINE, CENTRAL, and CINAHL were searched from inception to April, 2021 for studies reporting preoperative opioid use and its effect on postoperative outcomes or opioid use. The search, data extraction and methodologic assessment were performed in duplicate for all included studies. Twenty-one studies with a total of 257,301 patients were included in the final synthesis. Of which, 17 were level III evidence. Of those, 51.5% of the patients reported pre-operative opioid use. Fourteen studies (66.7%) reported a higher likelihood of opioid use at follow-up among those used opioids preoperatively compared to preoperative opioid-naïve patients. Eight studies (38.1%) showed lower functional measurements and range of motion in opioid group compared to the non-opioid group post-operatively. Preoperative opioid use in patients undergoing shoulder surgeries is associated with lower functional scores and post-operative range of motion. Most concerning is preoperative opioid use may predict increased post-operative opioid requirements and potential for misuse in patients. Level IV, Systematic review.