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Joint Range of Motion After Total Shoulder Arthroplasty With and Without a Continuous Interscalene Nerve Block: A Retrospective, Case-Control Study
  1. Brian M. Ilfeld, M.D., M.S.,
  2. Thomas W. Wright, M.D.,
  3. Kayser F. Enneking, M.D. and
  4. Timothy E. Morey, M.D.
  1. From the Department of Anesthesiology, (B.M.I., F.K.E.,T.E.M.) and Orthopedics and Rehabilitation (T.W.W., F.K.E.), University of Florida College of Medicine, Gainesville, FL.
  1. Reprint requests: Brian M. Ilfeld, M.D., Department of Anesthesiology, P.O. Box 100254, 1600 SW Archer Road, Gainesville, FL 32610-0254. E-mail: bilfeld{at}


Background and Objectives Although a continuous interscalene nerve block (CISB) has been shown to provide potent analgesia after major shoulder surgery, its potential effects on postoperative rehabilitation remain uninvestigated. Therefore, this retrospective case-control study was undertaken to determine the association between CISB and joint range-of-motion after total shoulder arthroplasty (TSA).

Methods The medical records for patients who underwent TSA at our institution in the previous 3 years were examined. Each patient with a CISB (cases) was matched with a patient without a CISB (controls) for the following variables: age, gender, and TSA type (primary v revision). Data collected included maximum shoulder elevation and external rotation (primary endpoints), along with pre- and postoperative pain scores.

Results Of 134 charts reviewed, 25 cases were matched with an equal number of controls. On postoperative day 1, patients with or without a CISB achieved a median (5th-95th percentiles) of 85% (51-100) and 33% (11-56) of their surgeon-defined goal for elevation (P = .048), respectively, and attained 100% (33-100) and 17% (−81-68) for external rotation (P < .001), respectively. The median numeric rating pain score (NRS) during shoulder movement for patients with CISB was 2.0 (0.0-8.7) versus 8.5 (1.8-10.0) for patients without CISB (P < .001). Least, median, and highest resting NRS for the 24 hours after surgery were 0.0 (0.0-5.8), 1.0 (0.0-6.4), and 3.0 (0.0-9.0) for patients with CISB, respectively, versus 2.0 (0.0-7.7), 6.0 (0.3-9.6), and 8.0 (0.0-10.0) for patients without CISB (P = .030, P < .001, and P < .001 between groups, respectively).

Conclusions The day after TSA, a CISB is associated with increased shoulder range of motion, most likely resulting from the potent analgesia these nerve blocks provide.

  • Continuous peripheral nerve block
  • Continuous interscalene block
  • Postoperative analgesia
  • Postoperative physical therapy
  • Postoperative rehabilitation

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