Comparing Two Methods of Pain Control After Shoulder Surgery

hanks to advances in pain control, shoulder surgery can be done on an out-patient basis. Interscalene nerve blocks, a form of regional anesthesia has made the postoperative period much easier. Pain is blocked after surgery from the upper neck to the elbow. There is less nausea, and the patient is more alert and able to move. These two factors allow for earlier discharge.

But there are some disadvantages to the nerve block. Sometimes the patient loses motor control and function until the block wears off. Nerve damage can occur but remains unknown in the recovery room. In this study, researchers compared the nerve block to a patient-controlled pain device and report the results.

All patients in both groups had shoulder surgery under general anesthesia by the same surgeon. The operations were done on an outpatient basis. Several different types of surgical procedures were done including rotator cuff or labral repairs, subacromial decompression, and joint manipulations.

Regional anesthesia lasted in the nerve block group for about six to eight hours after surgery. Patients using the pain-control analgesia (PCA) were told to push the button on the device whenever they felt pain. A small amount of lidocaine (numbing agent) was released into the joint with each push of the button.

Patients using the PCA slept better with fewer awakenings the first night after surgery. They were also more active during the first few days and took fewer pain meds. The authors conclude PCA is safe and effective for use after arthroscopic shoulder surgery. It can be used as an alternative when the interscalene block isn't available or can't be used.

David Chao, MD, et al. Postoperative Pain Management for Arthroscopic Shoulder Surgery: Interscalene Block Versus Patient-Controlled Infusion of 0.25% Bupivicaine. In The American Journal of Orthopedics. May 2006. Vol. 35. No. 5. Pp. 231-234.



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