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.
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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.
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