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THE EXPERIENCE OF CONTINUOUS INTER-SCALENE CATHETER BLOCK (CISB) FOR SHOULDER SURGERY IN A DISTRICT GENERAL HOSPITAL, LONDON
ESRA Academy. James A. Sep 8, 2016; 138359; 0197 Topic: Shoulder Surgery
Dr. Arul Prakash Pandian James
Dr. Arul Prakash Pandian James

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Abstract
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Background and Aims:


           Major shoulder surgeries can be successfully managed as day cases if the postoperative pain is managed well. Complex patients who would otherwise demand high dependency care can be treated as day cases with patient and carer education. This study was conducted to assess whether Continuous Inter-scalene catheter Block (CISB) would help achieve the above important outcomes.

Aims

         To determine the effects of CISB on

             •  Patient satisfaction 

             •  Side effects

             •  Re-admission rate

Methods:

 
              A policy was designed to educate the team regarding CISB. Patient information leaflets and post CISB care pathway were created. Inter-scalene catheter was inserted using ultrasound technique. An elastomeric infusion system containing Ropivacaine 0.2% running at 5ml/hr was used post-operatively. The patients were discharged with oral analgesic medications. The pain team followed-up the patients until day 3 and confirmed catheter removal by patients/carers.

Results:


  * This study included 32 major shoulder operations.

  * There were no re-admissions

  * Nineteen (59%) patients were discharged the same day. Thirteen patients (41%) were admitted as in-patients post operatively for surgical or social reasons.

  * The patient satisfaction was very good in 23 (71.87%) patients, good in 08 (25%) patients and satisfactory in 01 (3.12%) patient. None of the patients reported the CISB to be unsatisfactory.

  * Three patients (9.37%) had numbness in their upper limb which was settled by day two.

Conclusions:

     

     •   CISB can be done safely with minimal complications

     •   It improves patient satisfaction

     •   There is economic benefit to the hospital

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