These authors conducted a randomized controlled study to investigate the efficacy of local infiltration analgesia (LIA) and interscalene nerve block (ISB) for early postoperative pain control after total shoulder arthroplasty (TSA).
Patients in the ISB group received a continuous infusion of 0.2% ropivacaine by perineural catheter for 48 hours.
The surgeon injected 110 mL of 0.2% ropivacaine, 30 mg of ketoprofen, and 0.5 mg of epinephrine before TSA in the LIA group and inserted a catheter into the glenohumeral joint. The next morning, 10 mL of 0.2% ropivacaine, 30 mg of ketoprofen, and epinephrine were injected through the catheter, which was then removed.
The study included 99 patients (50 LIA and 49 ISB patients) with a mean age of 72 years.
No significant difference in the mean pain score was found between the 2 groups for the 48-hour postoperative period.
The study included 99 patients (50 LIA and 49 ISB patients) with a mean age of 72 years.
No significant difference in the mean pain score was found between the 2 groups for the 48-hour postoperative period.
The LIA group had significantly less severe pain (P = .003) and less opioid consumption (P = .01) in the recovery room.
Comment: This study suggests that injection of a cocktail of ropivacaine, ketoprofen, and epinephrine injected before placing the TSA components (50-mL flush in the tissues surrounding the glenoid, 50-mL flush around the humerus into the rotator capsule and cuff, and then 10 mL in the incision) may be as effective as an ISB in controlling pain in the recovery room.
Comment: This study suggests that injection of a cocktail of ropivacaine, ketoprofen, and epinephrine injected before placing the TSA components (50-mL flush in the tissues surrounding the glenoid, 50-mL flush around the humerus into the rotator capsule and cuff, and then 10 mL in the incision) may be as effective as an ISB in controlling pain in the recovery room.
In our practice, we find that nerve blocks and in-wound catheters are not necessary when a multimodal program of Celebrex, Gabepentin, and Tylenol is used along with patient-controlled analgesia (in the recovery room only). Patients on this program are able to do their own assisted range of motion exercises the night of surgery and usually able to leave the medical center on oral medications the next day.
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We have a new set of shoulder youtubes about the shoulder, check them out at this link.
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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
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