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. 2014 Feb 4;2014(2):CD007080.
doi: 10.1002/14651858.CD007080.pub2.

Continuous interscalene brachial plexus block versus parenteral analgesia for postoperative pain relief after major shoulder surgery

Hameed Ullah  1 , Khalid Samad, Fauzia A Khan
Affiliations

Continuous interscalene brachial plexus block versus parenteral analgesia for postoperative pain relief after major shoulder surgery

Hameed Ullah et al. Cochrane Database Syst Rev. .

Abstract

Background: Postoperative pain may lead to adverse effects on the body, which might result in an increase in morbidity. Its management therefore poses a unique challenge for the clinician. Major shoulder surgery is associated with severe postoperative pain, and different modalities are available to manage such pain, including opioid and non-opioid analgesics, local anaesthetics infiltrated into and around the shoulder joint and regional anaesthesia. All of these techniques, alone or in combination, have been used to treat the postoperative pain of major shoulder surgery but with varying success.

Objectives: The objective of this review was to compare the analgesic efficacy of continuous interscalene brachial plexus block (ISBPB) with parenteral opioid analgesia for pain relief after major shoulder surgery.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 12), MEDLINE (1950 to December 2012), EMBASE (1980 to December 2012), Web of Science (1954 to December 2012), CINAHL (1982 to December 2012) and bibliographies of published studies.

Selection criteria: We included randomized controlled trials assessing the effectiveness of continuous ISBPB compared with different forms of parenteral opioid analgesia in relieving pain in adult participants undergoing elective major shoulder surgery.

Data collection and analysis: Two review authors independently assessed trial quality and extracted outcome data.

Main results: We included two randomized controlled trials (147 participants). A total of 17 participants were excluded from one trial because of complications related to continuous ISBPB (16) or parenteral opioid analgesia (one). Thus we have information on 130 participants (66 in the continuous ISBPB group and 64 in the parenteral opioid group). The studies were clinically heterogeneous. No meta-analysis was undertaken. However, results of the two included studies showed better pain relief with continuous ISBPB following major shoulder surgery and a lower incidence of complications when interscalene block is performed under ultrasound guidance rather than without it.

Authors' conclusions: Because of the small number of studies (two) relevant to the subject and the high risk of bias of the selected studies, no reasonable conclusion can be drawn.

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Conflict of interest statement

Hameed Ullah: none known.

Khalid Samad: none known.

Fauzia A Khan: none known.

Figures

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1
Abstracts search flow diagram.
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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD007080

References

References to studies included in this review

Hofmann‐Kiefer 2008 {published data only}
    1. Hofmann‐Kiefer K, Eiser T, Chappell D, Leuschner S, Conzen P, Schwender D. Does patient‐controlled continuous interscalene brachial plexus block improve early functional rehabilitation after open shoulder surgery?. Anesthesia and Analgesia 2008;106:991‐6. - PubMed
Wei 2012 {published data only}
    1. Wei Y, Guo X‐Y, Yang L, Rong Y‐L, Xu CY, Li M. Effects of continuous interscalene brachial plexus block plus general anesthesia versus general anesthesia alone on perioperative management of arthroscopic rotator cuff repair surgery. National Medical Journal of China 2012;92:2327‐30. - PubMed

References to studies excluded from this review

Al‐Kaisy 1998 {published data only}
    1. Al‐Kaisy A, McGuire G, Chan VWS, Bruin G, Peng P, Miniaci A, et al. Analgesic effect of interscalene block using low‐dose bupivacaine for outpatient arthroscopic shoulder surgery. Regional Anesthesia and Pain Medicine 1998;23:469‐73. - PubMed
Bain 2001 {published data only}
    1. Bain GI, Rudkin G, Comley AS, Heptinstall RJ, Chittleborough M. Digitally assisted acromioplasty: the effect of interscalene block on this new surgical technique. Arthroscopy 2001;17:44‐9. - PubMed
Barber 2002 {published data only}
    1. Barber FA, Herbert MA. The effectiveness of an anesthetic continuous‐infusion device on postoperative pain control. Arthroscopy 2002;18:76‐81. - PubMed
Beaudet 2008 {published data only}
    1. Beaudet V, Williams SR, Tétreault P, Perrault MA. Perioperative interscalene block versus intra‐articular injection of local anesthetics for postoperative analgesia in shoulder surgery. Regional Anesthesia and Pain Medicine 2008;33:134‐8. - PubMed
Birnbaum 2007 {published data only}
    1. Birnbaum J, Kip M, Spies CD, Hein OV, Labs K, Moeckel G, et al. The effect of stimulating versus nonstimulating catheters for continuous interscalene plexus blocks in short‐term pain management. Journal of Clinical Anesthesia 2007;19:434‐9. - PubMed
Blumenthal 2005 {published data only}
    1. Blumenthal S, Dullenkopf A, Rentsch K, Borgeat A. Continuous infusion of ropivacaine for pain relief after iliac crest bone grafting for shoulder surgery. Anesthesiology 2005;102:392‐7. - PubMed
Borgeat 1997 {published data only}
    1. Borgeat A, Schäppi B, Biasca N, Gerber C. Patient‐controlled analgesia after major shoulder surgery: patient‐controlled interscalene analgesia versus patient‐controlled analgesia. Anesthesiology 1997;87:1343‐7. - PubMed
Borgeat 1998 {published data only}
    1. Borgeat A, Tewes E, Biasca N, Gerber C. Patient‐controlled interscalene analgesia with ropivacaine after major shoulder surgery: PCIA vs PCA. British Journal of Anaesthesia 1998;81:603‐5. - PubMed
Borgeat 2000 {published data only}
    1. Borgeat A, Perschak H, Bird P, Hodler J, Gerber C. Patient‐controlled interscalene analgesia with ropivacaine 0.2% versus patient‐controlled intravenous analgesia after major shoulder surgery: effects on diaphragmatic and respiratory function. Anesthesiology 2000;92:102‐8. - PubMed
Ciccone 2008 {published data only}
    1. Ciccone WJ II, Busey TD, Weinstein DM, Walden DL, Elias JJ. Assessment of pain relief provided by interscalene regional block and infusion pump after arthroscopic shoulder surgery. Arthroscopy 2008;24:14‐9. - PubMed
Contreras‐Domínguez 2008 {published data only}
    1. Contreras‐Domínguez V, Carbonell‐Bellolio P, Sanzana ES, Ojeda‐Greciet A, Orrego‐Santos A. Efficacy of a continuous interscalene block vs intra‐articular analgesia for postoperative pain in arthroscopic acromioplasty. Revista Española de Anestesiología y Reanimación 2008;55:475‐80. - PubMed
Culebras 2001 {published data only}
    1. Culebras X, Gessel E, Hoffmeyer P, Gamulin Z. Clonidine combined with a long acting local anesthetic does not prolong postoperative analgesia after brachial plexus block but does induce hemodynamic changes. Anesthesia and Analgesia 2001;92:199‐204. - PubMed
Delaunay 2005 {published data only}
    1. Delaunay L, Souron V, Lafosse L, Marret E, Toussaint B. Analgesia after arthroscopic rotator cuff repair: subacromial versus interscalene continuous infusion of ropivacaine. Regional Anesthesia and Pain Medicine 2005;30:117‐22. - PubMed
Dewees 2006 {published data only}
    1. Dewees JL, Schultz CT, Wilkerson FK, Kelly JA, Biegner AR, Pellegrini JE. Comparison of two approaches to brachial plexus anesthesia for proximal upper extremity surgery: interscalene and intersternocleidomastoid. American Association of Nurse Anesthetists 2006;74:201‐6. [16786913] - PubMed
Esteves 2002 {published data only}
    1. Esteves S, Sá P, Figueiredo D, Pèrez Souto A. Duration and quality of postoperative analgesia after brachial plexus block for shoulder surgery: ropivacaine 0.5% versus ropivacaine 0.5% plus clonidine. Revista Española de Anestesiologíay Reanimación 2002;49:302‐5. - PubMed
Fontana 2009 {published data only}
    1. Fontana C, Donato A, Giacomo G, Costantini A, Vita A, Lancia F, et al. Postoperative analgesia for arthroscopic shoulder surgery: a prospective randomized controlled study of intraarticular, subacromial injection, interscalenic brachial plexus block and intraarticular plus subacromial injection efficacy. European Journal of Anaesthesiology 2009;26:689‐93. - PubMed
Fredrickson 2010 {published data only}
    1. Fredrickson MJ, Ball CM, Dalgleish AJ. Analgesic effectiveness of a continuous versus single‐injection interscalene block for minor arthroscopic shoulder surgery. Regional Anesthesia and Pain Medicine 2010;35:28‐33. - PubMed
Fredrickson 2011 {published data only}
    1. Fredrickson MJ, Abeysekera A, Price DJ, Wong AC. Patient‐initiated mandatory boluses for ambulatory continuous interscalene analgesia: an effective strategy for optimizing analgesia and minimizing side‐effects. British Journal of Anaesthesia 2011;106:239‐45. - PubMed
Goebel 2010 {published data only}
    1. Goebel S, Stehle J, Schwemmer U, Reppenhagen S, Rath B, Gohlke F. Interscalene brachial plexus block for open‐shoulder surgery: a randomized, double‐blind, placebo‐controlled trial between single‐shot anesthesia and patient‐controlled catheter system. Archives of Orthopaedic and Trauma Surgery 2010;130:533‐40. - PubMed
Gohl 2001 {published data only}
    1. Gohl MR, Moeller RK, Olson RL, Vacchiano CA. The addition of interscalene block to general anesthesia for patients undergoing open shoulder procedures. American Association of Nurse Anesthetists 2001;69:105‐9. - PubMed
Gonano 2009 {published data only}
    1. Gonano C, Kettner SC, Ernstbrunner M, Schebesta K, Chiari A, Marhofer P. Comparison of economical aspects of interscalene brachial plexus blockade and general anaesthesia for arthroscopic shoulder surgery. British Journal of Anaesthesia 2009;103:428‐33. - PubMed
Grossi 1998 {published data only}
    1. Grossi P, Calliada S, Braga A, Caldara P, D'Aloia A, Coluccia R. Interscalene brachial plexus block combined with total intravenous anaesthesia and laryngeal mask airway for shoulder surgery. Anaesthesia 1998;53:20‐1. - PubMed
Hadzic 2005 {published data only}
    1. Hadzic A, Williams BA, Karaca PE, Hobeika P, Unis G, Dermksian J, et al. For outpatient rotator cuff surgery, nerve block anesthesia provides superior same‐day recovery over general anesthesia. Anesthesiology 2005;102:1001‐7. - PubMed
Ilfeld 2003 {published data only}
    1. Ilfeld BM, Morey TE, Wright TW, Chidgey LK, Enneking FK. Continuous interscalene brachial plexus block for postoperative pain control at home: a randomized, double‐blinded, placebo‐controlled study. Anesthesia and Analgesia 2003;96:1089‐95. - PubMed
Ilfeld 2006 {published data only}
    1. Ilfeld BM, Vandenborne K, Duncan PW, Sessler DI, Enneking FK, Shuster JJ, et al. Ambulatory continuous interscalene nerve blocks decrease the time to discharge readiness after total shoulder arthroplasty: a randomized, triple‐masked, placebo‐controlled study. Anesthesiology 2006;105:999‐1007. - PubMed
Iskandar 2003 {published data only}
    1. Iskandar H, Benard A, Ruel‐Raymond J, Cochard G, Manaud B. The analgesic effect of interscalene block using clonidine as an analgesic for shoulder arthroscopy. Anesthesia and Analgesia 2003;96:260‐2. - PubMed
Kean 2006 {published data only}
    1. Kean J, Wigderowitz CA, Coventry DM. Continuous interscalene infusion and single injection using levobupivacaine for analgesia after surgery of the shoulder. A double‐blind, randomised controlled trial. The Journal of Bone and Joint Surgery. British volume 2006;88:1173‐7. - PubMed
Kinnard 1994 {published data only}
    1. Kinnard P, Truchon R, St‐Pierre A, Montreuil J. Interscalene block for pain relief after shoulder surgery. A prospective randomized study. Clinical Orthopaedics and Related Research 1994;304:22‐4. - PubMed
Klein 2000 {published data only}
    1. Klein SM, Grant SA, Greengrass RA, Nielsen KC, Speer KP, White W, et al. Interscalene brachial plexus block with a continuous catheter insertion system and a disposable infusion pump. Anesthesia and Analgesia 2000;91:1473‐8. - PubMed
Klein 2001 {published data only}
    1. Klein SM, Nielsen KC, Martin A, White W, Warner DS, Steele SM, et al. Interscalene brachial plexus block with continuous intraarticular infusion of ropivacaine. Anesthesia and Analgesia 2001;93:601‐5. - PubMed
Klein 2003 {published data only}
    1. Klein SM, Steele SM, Nielsen KC, Pietrobon R, Warner DS, Martin A, et al. The difficulties of ambulatory interscalene and intra‐articular infusions for rotator cuff surgery: a preliminary report. Canadian Journal of Anaesthesia 2003;50:265‐9. - PubMed
Laurila 2002 {published data only}
    1. Laurila PA, Löppönen A, Kangas‐Saarela T, Flinkkilä T, Salomäki TE. Interscalene brachial plexus block is superior to subacromial bursa block after arthroscopic shoulder surgery. Acta Anaesthesiologica Scandinavica 2002;46:10031‐6. - PubMed
Le 2008 {published data only}
    1. Le LT, Loland VJ, Mariano ER, Gerancher JC, Wadhwa AN, Renehan EM, et al. Effects of local anesthetic concentration and dose on continuous interscalene nerve blocks: a dual‐center, randomized, observer‐masked, controlled study. Regional Anesthesia and Pain Medicine 2008;33:518‐25. - PMC - PubMed
Lehtipalo 1999 {published data only}
    1. Lehtipalo S, Koskinen LO, Johansson G, Kolmodin J, Biber B. Continuous interscalene brachial plexus block for postoperative analgesia following shoulder surgery. Acta Anaesthesiologica Scandinavica 1999;43:258‐64. - PubMed
Mahmoodpoor 2011 {published data only}
    1. Mahmoodpoor A, Abedini N, Parish M, Jannati A, Baradaran R. Efficacy of low dose interscalene brachial plexus block on post anesthesia recovery parameters after shoulder surgery. Pakistan Journal of Medical Sciences 2011;27:265‐8.
Mariano 2009 {published data only}
    1. Mariano ER, Afra R, Loland VJ, Sandhu NS, Bellars RH, Bishop ML, et al. Continuous interscalene brachial plexus block via an ultrasound‐guided posterior approach: a randomized, triple‐masked, placebo‐controlled study. Anesthesia and Analgesia 2009;108:1688‐94. - PMC - PubMed
Muittari 1998 {published data only}
    1. Muittari P, Kirvelä O. The safety and efficacy of intrabursal oxycodone and bupivacaine in analgesia after shoulder surgery. Regional Anesthesia and Pain Medicine 1998;23:474‐8. - PubMed
Nisar 2008 {published data only}
    1. Nisar A, Morris MW, Freeman JV, Cort JM, Rayner PR, Shahane SA. Subacromial bursa block is an effective alternative to interscalene block for postoperative pain control after arthroscopic subacromial decompression: a randomized trial. Journal of Shoulder and Elbow Surgery / American Shoulder and Elbow Surgeons 2008;17:78‐84. - PubMed
Patacsil 2008 {published data only}
    1. Patacsil JA, Wemette JP, Eborn TW, Daniel CA, Pellegrini JE. Intraartciular infusion pump vs an interscalene brachial plexus block for improved pain control in arthroscopic shoulder surgery. American Association of Nurse Anesthetists 2008;76:386.
Pennekamp 2004 {published data only}
    1. Pennekamp PH, Pless V, Kraft CN, Stütz A, Schmitt O, Diedrich O. Effectiveness of interscalene plexus block for open subacromion decompression. Deutsche Gesellschaft für Orthopädie und Orthopädische Chirirurgie 2004;142:598‐602. - PubMed
Pere 1993 {published data only}
    1. Pere P. The effect of continuous interscalene brachial plexus block with 0.125% bupivacaine plus fentanyl on diaphragmatic motility and ventilatory function. Regional Anesthesia 1993;18:93‐7. - PubMed
Sia 2003 {published data only}
    1. Sia S, Sarro F, Lepri A, Bartoli M. The effect of exogenous epinephrine on the incidence of hypotensive/bradycardic events during shoulder surgery in the sitting position during interscalene block. Anesthesia and Analgesia 2003;97:583‐8. - PubMed
Singelyn 1999 {published data only}
    1. Singelyn FJ, Seguy S, Gouverneur JM. Interscalene brachial plexus analgesia after open shoulder surgery: continuous versus patient‐controlled infusion. Anesthesia and Analgesia 1999;89:1216‐20. - PubMed
Singelyn 2004 {published data only}
    1. Singelyn FJ, Lhotel L, Fabre B. Pain relief after arthroscopic shoulder surgery: a comparison of intraarticular analgesia, suprascapular nerve block, and interscalene brachial plexus block. Anesthesia and Analgesia 2004;99:589‐92. - PubMed
Tamosiūnas 2004 {published data only}
    1. Tamosiūnas R, Gudas R, Karbonskiene A, Marchertiene I. Bupivacaine for continuous interscalene brachial plexus analgesia after shoulder surgery. Medicina 2004;40:351‐7. - PubMed

Additional references

Benumof 2000
    1. Benumof JL. Permanent loss of cervical spinal cord function associated with interscalene block performed under general anesthesia. Anesthesiology 2000;93:1541‐4. [MEDLINE: ] - PubMed
Bishop 2005
    1. Bishop JY, Sprague M, Gelber J, Krol M, Rosenblatt MA, Gladstone J, et al. Interscalene regional anaesthesia for shoulder surgery. The Journal of Bone and Joint Surgery. American volume 2005;87(5):974‐9. [MEDLINE: ] - PubMed
Borgeat 2007
    1. Borgeat A. New insights of anesthesia for shoulder surgery. Journal of Medical Science 2007;27:47‐54.
Desborough 2000
    1. Desborough JP. The stress response to trauma and surgery. British Journal of Anaesthesia 2000;85(1):109‐17. [MEDLINE: ] - PubMed
Egger 1997
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315(7109):629‐34. [MEDLINE: ] - PMC - PubMed
Fredrickson 2010a
    1. Fredrickson MJ, Krishnan S, Chen CY. Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques. Anaesthesia 2010;65:608‐24. [MEDLINE: ] - PubMed
Higgins 2011
    1. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2008.
Macintyre 2001
    1. Macintyre 2001. Safety and efficacy of patient‐controlled analgesia. British Journal of Anaesthesia 2001;87:36‐46. [MEDLINE: ] - PubMed
RevMan 5.1 [Computer program]
    1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan) [Computer program]. Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Russon 2006
    1. Russon K, Sardesai AM, Ridgway S, Whitear J, Sildown D, Boswell S, et al. Postoperative shoulder surgery initiative (POSSI): an interim report of major shoulder surgery as a day case procedure. British Journal of Anaesthesia 2006;97(6):869‐73. [MEDLINE: ] - PubMed
Tuominen 1987
    1. Tuominen M, Pitkanen M, Rosenberg PH. Postoperative pain relief and bupivacaine plasma levels during continuous interscalene brachial plexus block. Acta Anaesthesiologica Scandinavica 1987;31(4):276‐8. [MEDLINE: ] - PubMed
White 2005
    1. White PF. The changing role of non‐opioid analgesic techniques in the management of postoperative pain. Anesthesia and Analgesia 2005;101(5 Suppl):5‐22. [MEDLINE: ] - PubMed
Winnie 1970
    1. Winnie AP. Interscalene brachial plexus block. Anesthesia and Analgesia 1970;49(3):455‐66. [MEDLINE: ] - PubMed

References to other published versions of this review

Ullah 2008
    1. Ullah H, Samad K, Khan FA. Continuous interscalene brachial plexus block versus parenteral analgesia for postoperative pain relief after major shoulder surgery. Cochrane Database of Systematic Reviews 2008, Issue 2. [DOI: 10.1002/14651858.CD007080] - DOI - PMC - PubMed

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