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Original research
Postoperative neurological symptoms following arthroscopic shoulder surgery with interscalene block: an exploratory secondary analysis of pooled randomized controlled trial data
  1. Samantha Frost1,
  2. Daniel Rodrigues1,
  3. Ryan J J Amadeo1,
  4. Scott Wolfe1,
  5. Faylene Funk1,
  6. Celeste Ferguson2,
  7. Holly Brown2,
  8. Peter MacDonald2,
  9. Brenden Dufault3 and
  10. Thomas Charles Mutter1
  1. 1Anesthesiology, Perioperative and Pain Medicine, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
  2. 2Orthopedics, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
  3. 3George and Fay Yee Centre for Health Care Innovation, University of Manitoba Max Rady College of Medicine, Winnipeg, Manitoba, Canada
  1. Correspondence to Dr Thomas Charles Mutter, Anesthesiology, Perioperative and Pain Medicine, University of Manitoba Max Rady College of Medicine, Winnipeg, MB R3E 0Z2, Canada; tmutter{at}hotmail.com

Abstract

Objective Postoperative neurological symptoms (PONS) are recognized complications of regional anesthesia and orthopedic surgery. We aimed to better characterize prevalence and potential risk factors in a homogeneous population of randomized, controlled trial participants.

Methods Data were pooled from two randomized controlled trials of analgesia after interscalene block with perineural or intravenous adjuvants (NCT02426736, NCT03270033). Participants were at least 18 years of age and undergoing arthroscopic shoulder surgery at a single ambulatory surgical center. PONS were assessed by telephone follow-up at 14 days and 6 months postoperatively, and defined as patient report of numbness, weakness, or tingling in the surgical limb, alone or in combination, and regardless of severity or etiology.

Results At 14 days, PONS occurred in 83 of 477 patients (17.4%). Among these 83 patients, 10 (12.0%) continued to have symptoms a half-year after surgery. In exploratory univariate analyses, no patient, surgical or anesthetic characteristics were significantly associated with 14-day PONS except for lower postoperative day 1 Quality of Recovery-15 questionnaire total score (OR 0.97 (95% CI, 0.96 to 0.99), p<0.01). This result was driven largely by the emotional domain question scores (OR 0.90 95% CI 0.85 to 0.96, p<0.001). Report of all three of numbness, weakness and tingling at 14 days vs other 14-day symptom combinations was associated with persistent PONS at 6 months (OR 11.5 95% CI 2.2 to 61.8, p<0.01).

Conclusion PONS are common after arthroscopic shoulder surgery performed with single injection ultrasound-guided interscalene blocks. No definitive mitigating risk factors were identified.

  • Postoperative Complications
  • Brachial Plexus
  • Peripheral Nerve Injuries
  • Neurologic Manifestations

Data availability statement

Data are available on reasonable request. The authors will consider requests for data sharing.

https://doi.org/10.1136/rapm-2022-104086

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    Data availability statement

    Data are available on reasonable request. The authors will consider requests for data sharing.

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    Footnotes

    • Presented at Content from this manuscript was accepted for presentation as an abstract on June 10, 2023, at the Canadian Anesthesiologists' Society annual meeting.

    • Contributors TCM and SF: Substantial contributions to design, data acquisition, analysis and interpretation. Prepared drafts, revised them critically and provided approval of the final version. DR: Substantial contributions to design, data acquisition and interpretation. Revised the drafts critically and provided approval of the final version. RJJA, SW and PM: Substantial contributions to design and data interpretation. Revised the drafts critically and provided approval of the final version. FF, CF and HB: Substantial contributions to data acquisition. Revised the drafts critically and provided approval of the final version. BD: Substantial contributions to data analysis and interpretation. Revised the drafts critically and provided approval of the final version. TCM is the study guarantor.

    • Funding This study was funded by Pan Am Clinic Foundation, Canadian Anesthesia Research Foundation, University of Manitoba Department of Anesthesiology, Perioperative and Pain Medicine Oversight and Advisory Committee.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.