Does patient-controlled continuous interscalene block improve early functional rehabilitation after open shoulder surgery?

Anesth Analg. 2008 Mar;106(3):991-6, table of contents. doi: 10.1213/ane.0b013e31816151ab.

Abstract

Background: Early mobilization after shoulder surgery plays a vital role in successful functional rehabilitation. However, postoperative pain often reduces, or even prevents, effective physiotherapy. We investigated the effect of analgesia via patient-controlled interscalene technique on early functional rehabilitation after open shoulder surgery.

Methods: Eighty-seven patients were randomly assigned to one of two groups: patient-controlled continuous interscalene block (PCISB) and patient-controlled i.v. (opioid) analgesia (PCA). Interscalene block was performed preoperatively; otherwise analgesic protocols were started in the postanesthesia care unit and were continued for 72 h. Physiotherapy was performed for 60 min a day on day 2 and 3 after surgery according to a standardized protocol. Maximum mobility was defined as the range of motion that could be achieved with pain as the limiting factor. Efficiency of functional rehabilitation was evaluated 1 day before and 3 days after surgery with the help of a multimodal scoring system (Constant-Score) that evaluates pain, daily life activity, strength and range of motion. Maximum intensity of pain was also monitored via Visual Analog Scales for the first 72 h after surgery and during in-hospital physiotherapy.

Results: Constant-Score rates were significantly improved by the interscalene block. However, no significant differences in mobility and strength sub-scores were observed between the groups. Compared with PCA, PCISB proved to be beneficial concerning pain at rest at 6 h (P < 0.001), 24 h (P = 0.044), and 72 h (P = 0.013) and for pain during physiotherapy at 48 h after surgery (P = 0.016).

Conclusion: Compared with opioid-based PCA, PCISB improved analgesia, but not function, during early rehabilitation of the shoulder joint.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Amides / administration & dosage
  • Analgesia, Patient-Controlled / methods*
  • Analgesics, Opioid / administration & dosage*
  • Anesthetics, Local / administration & dosage*
  • Drug Administration Schedule
  • Female
  • Fentanyl / administration & dosage
  • Humans
  • Joint Diseases / drug therapy
  • Joint Diseases / physiopathology
  • Joint Diseases / rehabilitation
  • Joint Diseases / surgery*
  • Male
  • Middle Aged
  • Muscle Strength
  • Nerve Block*
  • Orthopedic Procedures / adverse effects*
  • Pain Measurement
  • Pain, Postoperative / etiology
  • Pain, Postoperative / physiopathology
  • Pain, Postoperative / prevention & control*
  • Physical Therapy Modalities
  • Prospective Studies
  • Range of Motion, Articular
  • Recovery of Function
  • Ropivacaine
  • Rotator Cuff / surgery
  • Shoulder Joint / physiopathology
  • Shoulder Joint / surgery
  • Shoulder Pain / etiology
  • Shoulder Pain / physiopathology
  • Shoulder Pain / prevention & control*
  • Time Factors

Substances

  • Amides
  • Analgesics, Opioid
  • Anesthetics, Local
  • Ropivacaine
  • Fentanyl