Local Infiltration Analgesia Versus Interscalene Block for Pain Management Following Shoulder Arthroplasty A Prospective Randomized Clinical Trial

These authors point out that while interscalene blocks can provide effective analgesia following shoulder arthroplasty, they risk serious complications in 5% to 16% of cases, including infection, pneumothorax, hematoma, peripheral nerve injuries, Horner syndrome, phrenic nerve palsy, respiratory distress and “rebound” pain as the block wears off. They also alter sensory and motor function of the upper extremity, removing protective sensation and precluding accurate neurologic examination in the immediate postoperative period. Finally, they are more expensive than local infiltration analgesia (LIA). See Interscalene blocks for shoulder surgery - more costly and more risky. and Interscalene block complications

The purpose of their study was to compare pain and opioid consumption between LIA and an interscalene block following shoulder arthroplasty in a prospective randomized clinical trial of patients undergoing primary shoulder arthroplasty.

Both groups had general anesthetics. The block group (n=37) received a preoperative interscalene block using liposomal bupivacaine, and the injection group (n=37) received an intraoperative LIA injection of ropivacaine, epinephrine, ketorolac, and normal saline solution.

The mean hospital charge for the interscalene block procedure was $1,718, which was over ten times greater than that for LIA injection ($157). The difference in anesthesia professional fees and total procedure time were not presented. The mean hospital length of stay was significantly longer for the patients receiving blocks.

There was no significant difference in opioid consumption between the groups at any time points postoperatively.

In noninferiority testing for the mean pain scores during the first 24 hours, the injection group was found to be noninferior to the block group.

One patient in the block group developed transient phrenic nerve palsy with hypoxemia. One patient in the injection group developed dislocation after reverse arthroplasty related to noncompliance.

In this study local infiltration analgesia was of substantially greater value than interscalene block because both methods provided similar analgesia while interscalene block was over ten times more costly and risked serious complications.

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