Peer-Reviewed Journal Details
Mandatory Fields
Vorobeichik, L,Brull, R,Bowry, R,Laffey, JG,Abdallah, FW
2018
April
British Journal Of Anaesthesia
Should continuous rather than single-injection interscalene block be routinely offered for major shoulder surgery? A meta-analysis of the analgesic and side-effects profiles
Published
Optional Fields
analgesia postoperative pain shoulder BRACHIAL-PLEXUS BLOCK PERIPHERAL-NERVE BLOCKS RANDOMIZED-CONTROLLED-TRIALS POSTOPERATIVE PAIN-CONTROL ROTATOR CUFF REPAIR PERINEURAL DEXMEDETOMIDINE 0.125-PERCENT BUPIVACAINE DIAPHRAGMATIC MOTILITY VENTILATORY FUNCTION REGIONAL ANESTHESIA
120
679
692
Background: Major shoulder surgery is associated with moderate-to-severe pain, but consensus on the optimal analgesic approach is lacking. Continuous catheter-based interscalene block (CISB) prolongs the analgesic benefits of its single-injection counterpart (SISB), but concerns over CISB complications and difficulties in interpreting comparative evidence examining major and minor shoulder procedures simultaneously, despite their differences in postoperative pain, have limited CISB popularity. This meta-analysis evaluates the CISB analgesic role and complications compared with SISB for major shoulder surgery.Methods: We retrieved randomised controlled trials (RCTs) comparing the effects of CISB to SISB on analgesic outcomes and side-effects after major shoulder surgery. Postoperative opioid consumption at 24 h was designated as the primary outcome. Secondary outcomes included 24-48 h opioid consumption, postoperative rest and dynamic pain scores up to 72 h, time-to-first analgesic, recovery room and hospital stay durations, patient satisfaction, postoperative nausea and vomiting, respiratory function, and block-related complications.Results: Data from 15 RCTs were pooled using random-effects modelling. Compared with SISB, CISB reduced 24-and 48-h oral morphine consumption by a weighted mean difference [95% confidenceinterval] of 50.9 mg[-81.6, -20.2], (P = 0.001) and 44.7 mg[-80.9,-8.7], (P<0.0001), respectively. Additionally, CISB provided superior rest and dynamic pain control beyond 48 h, prolonged time-to-first analgesic, enhanced satisfaction, and reduced postoperative nausea and vomiting without complications. CISB caused an 11.0-11.7% decrease in respiratory indices. Result heterogeneity was successfully explained.Conclusions: High-level evidence indicates that CISB provides superior analgesia up to 48 h after major shoulder surgery, without increasing side-effects, compared with SISB. The importance of CISB-related changes in respiratory indices is questionable.
10.1016/j.bja.2017.11.104
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