These authors point out that interscalene brachial plexus block can be an effective anesthetic technique for shoulder arthroplasty lasting for about 8 hours after surgery; but that “rebound pain” can intensify the patient’s postoperative pain and narcotic usage when the block wears off.
They evaluated the use of Exparel (liposomal bupivacaine) injected into the soft tissues at the surgical site in reducing the postoperative pain scores and narcotic consumption following shoulder arthroplasty performed with interscalene block.
They found that patients treated with Exparel required significantly more postoperative narcotics and demonstrated no significant reduction in pain scores over the first 72 hours after primary shoulder arthroplasty. An explanation for this increase was not determined in this study.
Data above are for first 24 h after surgery
Comment: The problem of "rebound pain" is one of several downsides of interscalene block, especially since it is likely to occur in the evening or night after surgery. After an interscalene block (with or without Exparel) the pain starts to increase 8 hours after surgery and continued to rise until 24 hours post op. This post-block rebound pain can inconvenience patients, family, nurses, and housestaff.
This randomized controlled trial showed that Exparel was not effective in managing the problem of rebound pain after an interscalene block.
As these authors point out in a previous report (see link), "The optimal postoperative pain regimen for shoulder arthroplasty and the cost-effectiveness of analgesic techniques require further investigation."
=====
We have a new set of shoulder youtubes about the shoulder, check them out at this link.Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
Use the "Search" box to the right to find other topics of interest to you.
How you can support progress in shoulder surgery
You may be interested in some of our most visited web pages arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
