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Abstract
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Background and Aims Postoperative-pain management in shoulder arthroscopy surgeries, traditionally involves an interscalene brachial-plexus block. Since the shoulder receives innervation through the suprascapular, axillary, lateral pectoral and subscapularis nerves, a more distal block was conceptualized to provide an infra-omohyoid suprascapular nerve and subscapularis plane block, which we termed as ‘shoulder block’. The primary outcome variable was incidence of rebound pain(transient acute-pain post-block resolution); secondary outcomes included NRS at various time points, time to rescue-analgesic (TTRA-tramadol), patient satisfaction, sleep disturbance and incidence of diaphragmatic-paresis(DP).
Methods 20 ASA-I and II patients undergoing arthroscopic rotator cuff repair, were given an ultrasound-guided (Fijifilm sonosite edge 2) shoulder block(total 20ml 0.25% bupivacaine). General anaesthesia was induced prior to blocks with standard protocol. Prior to skin closure, all patients received intravenous diclofenac(75mg) and 1gm-PCM(8hourly thereafter). Postoperatively, time to rebound pain (NRS value ≥7 after block resolution was taken as criterion for evaluating rebound pain), NRS at various time points, total opioid consumption, sleep disturbance and patient satisfaction-scores were noted. Diaphragmatic function(using USG) was noted at 2 hours postoperatively in recovery.
Results In 1/20 patient with the NRS>7 (RPS), tramadol(50 mg around 12hours postop) was required. In 5/20 patients with NRS> 4, tramadol(one dose) was needed[figure 1].The TTRA was a mean of 603mins[bell-curve-figure 2]. Sleep disturbance (3/20), patient satisfaction score (>90%)and incidence of mild DP (3/20)were other observed variables .
Bar diagram showing median of NRS(numeric rating scale)values at different time-points over 24hrs with maximum NRS-4 seen around 10-12 hours
Bell-curve showing time to rescue analgesic(TTRA)i.e tramadol(50mg) requirement over 24hours with average maximum seen at 603 minutes
Conclusions Our study demonstrates significant reduction in rebound pain (NRS>7) and opioid consumption after ‘shoulder block’ in shoulder arthroscopic surgeries. However, a further comparative trial is mandatory with the gold standard-interscalene block.