Local infiltration analgesia versus interscalene nerve block for postoperative pain control after shoulder arthroplasty: a prospective, randomized, comparative noninferiority study involving 99 patients.
Aged
Aged, 80 and over
Analgesia
Analgesics, Opioid
/ therapeutic use
Anesthesia, Local
Anesthetics, Local
Anti-Inflammatory Agents, Non-Steroidal
Arthroplasty, Replacement, Shoulder
/ adverse effects
Female
Humans
Ketoprofen
Male
Middle Aged
Nerve Block
Pain Measurement
Pain, Postoperative
/ etiology
Prospective Studies
Ropivacaine
Total shoulder arthroplasty
early postoperative pain
interscalene nerve block
local infiltration analgesia
noninferiority study
opioid consumption
Journal
Journal of shoulder and elbow surgery
ISSN: 1532-6500
Titre abrégé: J Shoulder Elbow Surg
Pays: United States
ID NLM: 9206499
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
received:
29
05
2018
revised:
19
09
2018
accepted:
22
09
2018
pubmed:
14
12
2018
medline:
14
3
2019
entrez:
15
12
2018
Statut:
ppublish
Résumé
The aim of this study was to compare the efficacy of local infiltration analgesia (LIA) and interscalene nerve block (ISB) for early postoperative pain control after total shoulder arthroplasty (TSA). The hypothesis was that LIA is not inferior to ISB. A prospective, randomized controlled study was performed in 2014-2016. All patients who underwent TSA for shoulder osteoarthritis were included. Patients in the ISB group received a continuous infusion of 0.2% ropivacaine by perineural catheter for 48 hours. The surgeon injected 110 mL of 0.2% ropivacaine, 30 mg of ketoprofen, and 0.5 mg of epinephrine before TSA in the LIA group and inserted a catheter into the glenohumeral joint. The next morning, 10 mL of 0.2% ropivacaine, 30 mg of ketoprofen, and epinephrine were injected through the catheter, which was then removed. The primary outcome was the mean shoulder pain score for the 48-hour postoperative period on a numerical scale (0-10). The secondary outcomes were postoperative opioid requirements, complications, and shoulder function at the 1-month follow-up visit. The sample size was calculated for a noninferiority study. The study included 99 patients (50 LIA and 49 ISB patients) with a mean age of 72 ± 9.6 years. Although no significant difference in the mean pain score was found between the 2 groups for the 48-hour postoperative period (1.4 ± 0.9 for LIA vs 1.7 ± 1 for ISB, P = .19), the LIA group had significantly less severe pain (P = .003) and less opioid consumption (P = .01) in the recovery room. No complications occurred. A negative but nonsignificant correlation was found between postoperative pain and Constant score at the 1-month follow-up. LIA is not less effective than ISB for early postoperative pain control after TSA.
Sections du résumé
BACKGROUND
BACKGROUND
The aim of this study was to compare the efficacy of local infiltration analgesia (LIA) and interscalene nerve block (ISB) for early postoperative pain control after total shoulder arthroplasty (TSA). The hypothesis was that LIA is not inferior to ISB.
METHODS
METHODS
A prospective, randomized controlled study was performed in 2014-2016. All patients who underwent TSA for shoulder osteoarthritis were included. Patients in the ISB group received a continuous infusion of 0.2% ropivacaine by perineural catheter for 48 hours. The surgeon injected 110 mL of 0.2% ropivacaine, 30 mg of ketoprofen, and 0.5 mg of epinephrine before TSA in the LIA group and inserted a catheter into the glenohumeral joint. The next morning, 10 mL of 0.2% ropivacaine, 30 mg of ketoprofen, and epinephrine were injected through the catheter, which was then removed. The primary outcome was the mean shoulder pain score for the 48-hour postoperative period on a numerical scale (0-10). The secondary outcomes were postoperative opioid requirements, complications, and shoulder function at the 1-month follow-up visit. The sample size was calculated for a noninferiority study.
RESULTS
RESULTS
The study included 99 patients (50 LIA and 49 ISB patients) with a mean age of 72 ± 9.6 years. Although no significant difference in the mean pain score was found between the 2 groups for the 48-hour postoperative period (1.4 ± 0.9 for LIA vs 1.7 ± 1 for ISB, P = .19), the LIA group had significantly less severe pain (P = .003) and less opioid consumption (P = .01) in the recovery room. No complications occurred. A negative but nonsignificant correlation was found between postoperative pain and Constant score at the 1-month follow-up.
CONCLUSION
CONCLUSIONS
LIA is not less effective than ISB for early postoperative pain control after TSA.
Identifiants
pubmed: 30545786
pii: S1058-2746(18)30716-X
doi: 10.1016/j.jse.2018.09.026
pii:
doi:
Substances chimiques
Analgesics, Opioid
0
Anesthetics, Local
0
Anti-Inflammatory Agents, Non-Steroidal
0
Ropivacaine
7IO5LYA57N
Ketoprofen
90Y4QC304K
Types de publication
Comparative Study
Equivalence Trial
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
212-219Informations de copyright
Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.