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ESRA19-0406 Pain relief after shoulder surgery – what happens when the block wears off?
  1. C Mcivor,
  2. J Mitchell and
  3. J Ramsey
  1. University Hospital Ayr, Anaesthetics and Pain Medicine, Ayr, UK


Background and aims Brachial plexus blockade is an effective form of analgesia for shoulder surgery. Once the nerve block subsides the management of pain becomes a major challenge for anaesthetists. A standard for best practice suggests that 100% of patients should be satisfied with their pain management plan.

Methods Patient’s consented prior to surgery for a follow up telephone call 2–4 days post-operatively. It was agreed that formal ethics approval was not required and all data was anonymised. Detailed pain scores and analgesia requirements were explored on the follow up.

Results 30 patients identified, 8 lost to follow-up. The average blocks duration was 25.84 hours. 27% of patients reported severe pain at rest with 45% experiencing severe pain during movement. 36% of patients felt they did not have sufficient analgesia once discharged home. 8 out of 22 felt they needed stronger pain relief. All but 1 patient stated that they would have a repeat nerve block.

Once the nerve block wore off it was clear that a large number of patients had inadequate analgesia. Despite the introduction of oxycodone to supplement analgesia, and a patient information leaflet to give advice on pain relief, patients often did not take analgesia as prescribed.

Abstract ESRA19-0406 Figure 1

Conclusions Single injection brachial plexus blocks are limited to a time span shorter than the duration of moderate to severe post-operative pain. The gold standard technique is continuous interscalene blocks (CISB) albeit technically challenging. Future work should concentrate on overcoming the barriers to CISB and aim to increase its uptake.

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