Michael Vlessides
Clinical Anesthesiology ISSUE: SEPTEMBER 2012 | VOLUME: 38:9
San Diego—Brachial plexus blockade is known to provide superior postoperative pain control after shoulder arthroscopy, but few data point to the best approach to the nerve network.
Perhaps it does not matter after all. New evidence shows that patients perceive no difference in pain control or satisfaction with either a supraclavicular or interscalene block. Even so, the investigators, from the Hospital for Special Surgery, in New York City, noted that supraclavicular block might be preferable for its propensity to be less disruptive to hemidiaphragmatic function. Paralysis of the diaphragm during surgery has been linked to increased postoperative morbidity.
“Shoulder surgery is well known to be one of the most painful surgeries, particularly in the ambulatory setting where patients may or may not have appropriate education about when to take pain medications,” said Stephen Haskins, MD, chief resident at NewYork-Presbyterian/Weill Cornell Medical Center in New York City, who helped conduct the study. “At the Hospital for Special Surgery, about 90% of these surgeries are done under brachial plexus block, so we decided to look more closely for any differences in postoperative pain control and patient satisfaction based on the specific approach we utilized.”
Dr. Haskins and his colleagues performed a prospective cohort trial on 100 patients undergoing ambulatory arthroscopic shoulder surgery under brachial plexus block. Patients completed an online or phone survey on postoperative day 2 or 3, during which they assessed postoperative pain, along with their level of satisfaction with the analgesia, the duration of the nerve block and the pain education they received before surgery.
The majority of the blocks—73%—were performed using the supraclavicular approach, which is typical at the researchers’ institution, Dr. Haskins said. Most consisted of a combination of mepivacaine and bupivacaine, he added.
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