Background and Aims Shoulder surgery causes significant post-operative pain needing large doses of opioids associated with adverse effects (1). Regional blocks reduce opioid requirements allowing early functional recovery and discharge (2). A study has shown that a Shoulder Arthroplasty enhanced Recovery Protocol(ShARP) has significantly reduced the length of stay (3). We plan to introduce a protocol in our hospital and, therefore, conducted this audit following approval from institutional ethics committee (see Figure 1).
Methods We analysed charts of patients who had elective arthroscopic shoulder surgery over 1-year period(Jan’20 – Jan’21). Comparison were then made between the patients who received a regional block and the patients who received systemic analgesic only. Primary outcome was the 24 hour cumulative oral opioid consumption. Secondary outcomes included pain scores at the PACU and 24 hours post-operatively, opioid related side-effects and regional anaesthesia related complications.
Results Charts of 87 patients were analysed (74 received regional block, 13 received systemic analgesics only). Demography and the preoperative opioid use was comparable between the groups (Table 1). 15 patients (13 with a block, 2 without) were discharged before 24 hours. Of the remaining 72, the mean morphine equivalent opioid consumption was significantly low in regional block group (Table 2). The mean pain score at recovery was significantly lower in block group but this difference was not statistically significant at 24 hours (Table 3).
Conclusions Our audit has shown that the 24-hour opioid requirements and recovery pain scores were less in patients who received the regional blocks. We plan to develop a ShARP protocol including regional blocks for our elective shoulder surgery patients.
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