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B333 A review of analgesic and anaesthetic strategies used in total scapulectomies at the royal orthopaedic hospital, Birmingham
  1. V Padmanabhan1 and
  2. B Smith2
  1. 1Worcestershire Acute Hospitals NHS Trust, Worcester, UK
  2. 2The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK


Background and Aims Total scapulectomy is a rarely performed orthopaedic oncological operation but as a specialist bone sarcoma unit we perform on an average, two such operations a year. There is a paucity of literature on optimal regional analgesic strategies to optimise post-operative pain management.1

We set out to review the notes of patients who had undergone a total scapulectomy over the last twenty years evaluating the trends in analgesic techniques and post-operative pain.

Methods Our oncology database identified forty total scapulectomy patients between 2001 and 2021 and of the available notes the anaesthetic charts, medication charts and post-operative pain scores were reviewed.

Results Sixteen sets of notes were available, the majority had either been destroyed due to the time since the operation or are in inaccessible storage. Two patients were under sixteen years old and were excluded. The patient group was heterogeneous and anaesthetic techniques used were varied. The earliest cases either used a morphine infusion or local anaesthetic infiltration.

More recently a combination of interscalene (ISB) and erector spinae blocks (ESP) have been preferred along with multimodal analgesia.

The best post-operative pain scores were found where local infiltration was combined with regional nerve block and catheter infusion than either alone.

Conclusions It is difficult to draw significant conclusions due to the small sample size but a combination of multi-modal analgesia along with local anaesthetic infiltration, regional nerve blocks and post-operative infusions appears optimal. The scapula has complex innervation from C3 to T5 and combination of ISB and ESP requires further prospective evaluation.2

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