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PAIN MANAGEMENT AFTER SHOULDER SURGERY : A PROSPECTIVE STUDY OF THE EFFICIENCY OF SINGLE-INJECTION INTERSCALENE BLOCK (ISB) FOR AMBULATORY PROCEDURES.
ESRA Academy. Cabaton J. Sep 8, 2016; 138491
Topic: Shoulder Surgery
Dr. Julien Cabaton
Dr. Julien Cabaton

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Abstract
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Background and Aims:

Ambulatory shoulder surgery is nowadays getting developed in France. Before discharging our patients the night after surgery, we decided to study if our pain management, based on single-injection ISB, was efficient (J Shoulder Elbow Surg. 2016)

Methods:

During 4 months, all patients having Arthroscopic Rotator Cuff Repairs (ARCR) were evaluated.

All patients had interscalene brachial plexus block associated with  general anesthesia, and received oral pain killers, including oral morphine. They were discharged from hospital the day after surgery (DAY 1) and were called at home by a nurse the following day (DAY 2). The anesthesiologists in charge of those patients were free to use the technique and local anesthetic they wanted.
General anesthesia protocol and postoperative oral pain killers were similar. 

Results:

323 patients underwent ARCR :
- 44% had ultrasound-guided ISB
- 93% levobupivacain, 7% ropivacain 
- 67% perineurial clonidine, 95% IV dexamethason

At DAY 1 :  19% had VAS>3;  26% required oral morphine.

At DAY 2, 156 patient answered to the phone survey :
- 33% had VAS>3
- 54% required oral morphine
- 12% complained from PONV
- 99% were very satisfied 

A univariate logistic model analysis showed that the use of perineural clonidin (p=0.016) increased VAS at DAY 1, which was unexpected and may be caused by a too small number of patients. No predictive factor was found for VAS at DAY 2. 

Conclusions:

A pain management based on ISB, without perineurial catheter, seems possible for Ambulatory ARCR Surgery.  However, pain at DAY 2 remains concerning, requiring the use of morphine at home. 

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