Korean J Pain.  2015 Jan;28(1):45-51. 10.3344/kjp.2015.28.1.45.

A Comparison of Three Methods for Postoperative Pain Control in Patients Undergoing Arthroscopic Shoulder Surgery

• Park SK
• Choi YS
• Choi SW
• Song SW

• KMID: 2278252
• DOI: http://doi.org/10.3344/kjp.2015.28.1.45

Abstract

BACKGROUND
Arthroscopic shoulder operations (ASS) are often associated with severe postoperative pain. Nerve blocks have been studied for pain in shoulder surgeries. Interscalene brachial plexus blocks (ISB) and an intra-articular injection (IA) have been reported in many studies. The aim of the present study is to evaluate the effect of ISB, a continuous cervical epidural block (CCE) and IA as a means of postoperative pain control and to study the influence of these procedures on postoperative analgesic consumption and after ASS.
METHODS
Fifty seven patients who underwent ASS under general anesthesia were randomly assigned to one of three groups: the ISB group (n = 19), the CCE group (n = 19), and the IA group (n = 19). Patients in each group were evaluated on a postoperative numerical rating scale (NRS), their rescue opioid dosage (ROD), and side effects.
RESULTS
Postoperative NRSs were found to be higher in the IA group than in the ISB and CCE groups both at rest and on movement. The ROD were 1.6 +/- 2.3, 3.0 +/- 4.9 and 7.1 +/- 7.9 mg morphine equivalent dose in groups CCE, ISB, and IA groups (P = 0.001), respectively, and statistically significant differences were noted between the CCE and IA groups (P = 0.01) but not in between the ISB and CCE groups.
CONCLUSIONS
This prospective, randomized study demonstrated that ISB is as effective analgesic technique as a CCE for postoperative pain control in patients undergoing ASS.

Keyword

Analgesia; Arthroscopy; Epidural anesthesia; Interscalene block; Intraarticular injection; Pain

MeSH Terms

Analgesia
Anesthesia, Epidural
Anesthesia, General
Arthroscopy
Brachial Plexus
Equidae
Humans
Injections, Intra-Articular
Morphine
Nerve Block
Pain, Postoperative*
Prospective Studies
Shoulder*
Morphine

Figure

• 

  Fig. 1 Changes in NRS pain score at rest (A), on movement (B), NRS scores (mean ± SD) were measured at 30 minutes, 4 hours, 24 hours, 48 hours after surgery. ISB: interscalene brachial plexus block, CCE: continuous cervical epidural block, IA: intraarticular injection, *P < 0.05 compared with the CCE group; †P < 0.05 when compared with the IA group.

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