The efficacy of an interscalene brachial plexus block in relieving postoperative pain after an arthroscopic rotator cuff reconstruction: Retrospective study

Abstract

Background: Rotator cuff tears are among the most common causes for an arthroscopic shoulder surgery. Movement of the limb is essential for successful recovery and paramount for well controlled postoperative pain (POP). The efficacy of the interscalene brachial plexus block (ISB) in relieving POP in homecare setting was evaluated. The research is expected to call our attention to the shortcomings of ISB and point out a possible need to adjust the prescribed oral analgesic therapy. Methods: A retrospective analysis of 150 patients was conducted. They had all undergone arthroscopic shoulder surgery due to the rotator cuff tear and received 12–30 mL levobupivacaine with dexamethasone preoperatively with ultrasound-guided ISB. POP was assessed with the Visual Analogue Scale (VAS). Patients’ demographical and clinical features were assessed as well as the duration of ISB and the analgesics consumption. VAS values were analysed 90 hours after surgery at rest and on movement. Patients’ satisfaction was assessed as well. Wilcoxon rank-sum test was used for comparison of the VAS values between descriptive variables. In the analysis of different levels of POP within the same patient, Repeated Measures Analysis of Variance (ANOVA) was used. A value of p < 0.05 was considered statistically significant. Results: The mean duration of ISB effect was 24–36 hours. In total, 77 additional doses of opioids and 104 doses of non-opioid analgesics were required during the first three post-operative days (POD). The median VAS value of the early POP was 0, both at rest and on movement. POP was 0.5 on movement and 1 at rest on the first POD, 2 and 3 on the second POD, 2 and 2 on the third POD. No significant differences were found between POP on movement and at rest (p > 0.05; Repeated Measures ANOVA). Most patients had been comfortable during surgery as well as later on the ward and at home. Conclusion: ISB is effective in relieving POP after arthroscopic rotator cuff repair in home care after hospital discharge. It provides more than 24-hour analgesia, but can cause intra-operative haemodynamic instability. The prescribed analgesic therapy is efficient. VAS values are satisfactory at rest and on movement. ISB is safe, uncomplicated and reliable in addition to high patients’ satisfaction. We conclude that ISB is the most appropriate method for arthroscopic shoulder surgery.