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Efficacy of arthroscopically placed pain catheter adjacent to the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block) following arthroscopic rotator-cuff repair.

ABSTRACT: BACKGROUND: Rotator-cuff surgery is well recognized to be a painful procedure. OBJECTIVES: The purpose of this study was to examine the effectiveness of an arthroscopically placed perineural catheter at the scapular notch to provide a continuous block of the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block [ca-SSNB]) following arthroscopic rotator-cuff repair (ARCR). MATERIALS AND METHODS: This level II, prospective, randomized, controlled trial without postoperative blinding included 40 patients, who had a 48-hour pain pump, with 0.2% ropivacaine infusion and a continuous rate of 3 mL/hour, placed via an arthroscopically placed catheter following ARCR with arthroscopic release of the superior transverse ligament: 21 patients had a ca-SSNB, and 19 patients had a continuous subacromial bursal block (SAB). The visual analog scale (at 6 hours and on the first, second, and third postoperative days) and the total number of additional pain-reduction attempts during the 3 postoperative days were calculated. RESULTS: The respective visual analog scale scores (mm) obtained from the ca-SSNB and SAB groups were 62.4 and 67.6 (P=0.73) before surgery, 9.1 and 19.4 (P=0.12) at 6 hours after surgery, 24.4 and 44.6 (P=0.019) on the first postoperative day, 19.4 and 40.4 (P=0.0060) on the second postoperative day, and 18.5 and 27.8 (P=0.21) on the third postoperative day. Total additional pain-reduction attempts recorded for the ca-SSNB and SAB groups during the 3 postoperative days were 0.3 times and 1.2 times (P=0.0020), respectively. CONCLUSION: ca-SSNB was highly effective in controlling postoperative pain after ARCR.

SUBMITTER: Yamakado K

PROVIDER: S-EPMC4074897 | biostudies-other | 2014

REPOSITORIES: biostudies-other

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Efficacy of arthroscopically placed pain catheter adjacent to the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block) following arthroscopic rotator-cuff repair.

Yamakado Kotaro K

Open access journal of sports medicine 20140521

<h4>Background</h4>Rotator-cuff surgery is well recognized to be a painful procedure.<h4>Objectives</h4>The purpose of this study was to examine the effectiveness of an arthroscopically placed perineural catheter at the scapular notch to provide a continuous block of the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block [ca-SSNB]) following arthroscopic rotator-cuff repair (ARCR).<h4>Materials and methods</h4>This level II, prospective, randomized, controlled tr ...[more]

PMID: 24982592

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Project description:PURPOSE:Suprascapular nerve block (SSNB) is the most commonly used block for the relief of postoperative pain from arthroscopic rotator cuff repair and can be used in combination with axillary nerve block (ANB). Dexmedetomidine (DEX) is a type of alpha agonist that can elongate the duration of regional block. The aim of this study was to compare the effects of the use of dexmedetomidine combined with SSNB and ANB with those of the use of SSNB and ANB alone on postoperative pain, satisfaction, and pain-related cytokines within the first 48 h after arthroscopic rotator cuff repair. METHODS:Forty patients with rotator cuff tears who had undergone arthroscopic rotator cuff repair were enrolled in this single-center, double-blinded randomized controlled trial study. Twenty patients were randomly allocated to group 1 and received ultrasound-guided SSNB and ANB using a mixture of 0.5 ml (50 ?g) of DEX and 9.5 ml of 0.75% ropivacaine preemptively. The other 20 patients were allocated to group 2 and underwent ultrasound-guided SSNB and ANB alone using a mixture of 0.5 ml of normal saline and 9.5 ml of ropivacaine. The visual analog scale (VAS) for pain and patient satisfaction (SAT) scores were postoperatively checked within 48 h. The plasma interleukin (IL)-6, IL-8, IL-1?, cortisol, and serotonin levels were also postoperatively measured within 48 h. RESULTS:Group 1 showed a significantly lower mean VAS (visual analog scale of pain) score 1, 3, 6, 12, 18 and 24 h after operation, and a significantly higher mean SAT (patient satisfaction) score 1, 3, 6, 12, 18, 24 and 36 h after the operation than group 2. Group 1 showed a significantly lower mean plasma IL-8 level 1 and 48 h after the operation, and a significantly lower mean IL-1? level 48 h after the operation than group 2. Group 1 showed a significantly lower mean plasma serotonin level 12 h after the operation than group 2. The mean timing of rebound pain in group 1 was significantly later than that in group 2 (36 h?>?23 h, p?=?0.007). Six patients each in groups 1 and 2 showed rebound pain. The others did not show rebound pain. CONCLUSIONS:Ultrasound-guided SSNA and ANB with DEX during arthroscopic rotator cuff repair resulted in a significantly lower mean VAS score and a significantly higher mean SAT score within 48 h after the operation than SSNB and ANB alone. Additionally, SSNB and ANB with DEX tended to result in a later mean timing of rebound pain accompanied by significant changes in IL-8, IL-1?, and serotonin levels within 48 h after the operation. The present study could provide the basis for selecting objective parameters of postoperative pain in deciding the optimal use of medication for relieving pain. LEVEL OF EVIDENCE:Level I. TRIAL REGISTRATION:2015-20, ClinicalTrials.gov Identifier: NCT04398589. IRB NUMBER:2015-20, Hallym University Chuncheon Sacred Heart Hospital.

Project description:PurposeTo determine whether anterior cable tears could be identified at the time of arthroscopic rotator cuff repair and determine the characteristics of the anterior cable tears identified.MethodsFrom 2016 to 2017 all shoulder arthroscopies had data collected prospectively at the time of surgery, specifically including injury to the capsular and tendon zones of insertion on the greater tuberosity. Anterior cable position and degree of injury and medialization were recorded, as well as complete findings of the diagnostic arthroscopy. The inclusion criterion was primary shoulder arthroscopy. The exclusion criterion was any revision shoulder arthroscopy. All arthroscopic rotator cuff repairs (ARCR) were grouped together and all other nonarthroscopic rotator cuff repair surgeries (non-ARCR) were grouped together.ResultsIn total, 118 shoulder arthroscopies had data collected prospectively at the time of surgery: 90 primary shoulder arthroscopies met the inclusion criteria; 28 were excluded because they were revision surgeries. There were 42 patients in the ARCR group (Group 1). Six of these were partial tears, and 36 were full-thickness tears. There were 48 patients in the non-ARCR group (Group 2). The non-ARCR Group 2 served as an anatomic baseline for ARCR Group 1. In all 90 shoulders, the rotator cable and anterior cable were identified. Group 1 (ARCR) incidence of anterior cable tears with abnormal position was 71.4% compared to 2.1% in group 2 (non-ARCR) (P < .001) Group 1 (ARCR) incidence of anterior cable tears with normal anterior cable position (n = 12) was compared to abnormal anterior cable position (n = 30). Injury to the anterior footprint capsular and tendon zones were compared. Normal anterior cable position correlated with no or low-grade injury to anterior footprint capsular zone. (Nimura zone C1). Abnormal anterior cable displacement graded as moderate (n = 20) and severe (n = 10) were compared for injury to the anterior footprint. Moderate displacement correlated with complete or high grade injury to C1 in 85% and complete injury to R1 in 45% (P < .001 and .049). In severe displacement complete C1 injury was 100%, and complete R1 injury was 100% (P < .001 and .001).ConclusionsAnterior cable tears are universally identified in ARCR. Three patterns of medial displacement severity correlated with injury to a crucial insertion zone (C1) at the anterior footprint. The degree of anterior cable disruption at the anterior footprint and displacement was commonly disproportionately greater than the injury to the supraspinatus.Level of evidenceLevel III, diagnostic study.

Dataset Information

Efficacy of arthroscopically placed pain catheter adjacent to the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block) following arthroscopic rotator-cuff repair.

Publications

Efficacy of arthroscopically placed pain catheter adjacent to the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block) following arthroscopic rotator-cuff repair.

Similar Datasets

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