A 3-arm randomized clinical trial comparing interscalene blockade techniques with local infiltration analgesia for total shoulder arthroplasty

The ideal analgesic modality for total shoulder arthroplasty (TSA) remains controversial. We hypothesized that a multimodal analgesic pathway incorporating continuous interscalene blockade (ISB) provides better analgesic efficacy than both single-injection ISB and local infiltration analgesia. This...

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Bibliographic Details
Published in:Journal of shoulder and elbow surgery 2019-10, Vol.28 (10), p.e325-e338
Main Authors: Panchamia, Jason K., Amundson, Adam W., Jacob, Adam K., Sviggum, Hans P., Nguyen, Ngoc Tram V., Sanchez-Sotelo, Joaquin, Sperling, John W., Schroeder, Darrell R., Kopp, Sandra L., Johnson, Rebecca L.
Format: Article
Language:English
Subjects:
Aged
Analgesia - methods
Analgesics, Opioid - therapeutic use
Anesthetics, Local - administration & dosage
Arthroplasty, Replacement, Shoulder - adverse effects
ASES score
Brachial Plexus Block - adverse effects
Brachial Plexus Block - methods
Female
Humans
Injections
Interscalene nerve block
local infiltration analgesia
Male
Middle Aged
OBAS
Pain Management
Pain Measurement
Pain, Postoperative - etiology
Pain, Postoperative - prevention & control
Postoperative Period
Quality of Life
SF-12 score
Time Factors
total shoulder arthroplasty
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Summary:The ideal analgesic modality for total shoulder arthroplasty (TSA) remains controversial. We hypothesized that a multimodal analgesic pathway incorporating continuous interscalene blockade (ISB) provides better analgesic efficacy than both single-injection ISB and local infiltration analgesia. This single-center, parallel, unblinded, randomized clinical trial evaluated 129 adults undergoing primary TSA. Patients were allocated to single-injection ISB, continuous ISB, or local infiltration analgesia. The primary outcome was the Overall Benefit of Analgesia Score (range, 0 [best] to 28 [worst]) on postoperative day 1. Additional outcomes included pain scores, opioid consumption, quality of life, and postoperative complications in the first 24 hours, at 3 months, and at 1 year. We analyzed 125 patients (42 with single-injection ISB, 41 with continuous ISB, and 42 with local infiltration analgesia). The Overall Benefit of Analgesia Score was significantly improved in the continuous group (median [25th percentile, 75th percentile], 0 [0, 2]) compared with the single-injection group (2 [1, 4]; P = .002) and local infiltration analgesia group (3 [2, 4]; P < .001). Pain scores were significantly lower in the continuous group compared with the local infiltration analgesia group (P < .001 for all time points) and after 12 hours from ward arrival compared with the single-injection group (median [25th percentile, 75th percentile], 1.0 [0.0, 2.8] vs. 2.5 [0.0, 4.0]; P = .016). After postanesthesia recovery discharge, opioid consumption (oral morphine equivalents) was significantly lower in the continuous group (median [25th percentile, 75th percentile], 7.5 mg [0.0, 25.0 mg]) than in the local infiltration analgesia group (30 mg [15.0, 52.5 mg]; P < .001) and single-injection group (17.6 mg [7.5, 45.5 mg]; P = .010). No differences were found across groups for complications, 3-month outcomes, and 1-year outcomes. Continuous ISB provides superior analgesia compared with single-injection ISB and local infiltration analgesia in the first 24 hours after TSA.
ISSN:1058-2746
1532-6500
DOI:10.1016/j.jse.2019.05.013