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Background and Aims Total scapulectomy involves severe postoperative pain and requires continuous regional anaesthesia for its control. Our aim is to review the anaesthetic strategy and postoperative pain in patients undergoing this surgery.
Methods Our retrospective observational descriptive study reviewed the anaesthetic techniques and postoperative pain control (NPRS at rest and at movement) in 5 patients undergoing total scapulectomy and reconstruction with scapular prosthesis between 2014-2022 at our hospital. Ethics committee approval was requested (IIBSP-ARC-2023-71). Quantitative variables are presented as median (range).
Results All patients received a continuous interscalene block (CIB) (table 1). Three patients received another associated technique: single-shot paravertebral block (CIB+PVB)(n=1), paravertebral with catheter (CIB+ CPVB)(n=1) or superficial cervical plexus block (CIB+ SCB)(n=1). Surgical time was 4h (3-5), bleeding around 1L (0.5-1.5). All presented mild postoperative pain at rest (NPRS<3), except one patient (CIB+PRV) who presented severe pain (NPRS=9) due to failed CIB. When moving, all patients presented moderate pain (NPRS 6-8) requiring opioid rescue, except the patient with CIB+CPVB, who registered NPRS 1 at movement and NPRS 0 at rest. Morphine rescues were higher in patients with isolated CIB. Interscalene and paravertebral catheter were removed after 4 (2-7) and 7 days, respectively. Four patients needed blood transfusion. The ICU stay was 1 day (1-3) and hospital LOS 8 days (8-11).
Conclusions CIB associated to CPVB achieve the best analgesic results at rest and movement. Catheter placement entails greater technical difficulty for the benefit of better analgesic quality in the perioperative period, compared to isolated CIB, without increasing hospitalization days or postoperative complications.
Attachment Supporting ethics committe.pdf