• J Shoulder Elbow Surg · Feb 2019

    Multicenter Study Comparative Study

    Local infiltration analgesia versus interscalene nerve block for postoperative pain control after shoulder arthroplasty: a prospective, randomized, comparative noninferiority study involving 99 patients.

    • Julia Sicard, Shahnaz Klouche, Christel Conso, Nicolas Billot, Jean-Charles Auregan, Samuel Poulain, Florent Lespagnol, Nicolas Solignac, Thomas Bauer, Mathieu Ferrand, and Philippe Hardy.
    • Hôpitaux Universitaires Paris Ile-de-France Ouest, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France.
    • J Shoulder Elbow Surg. 2019 Feb 1; 28 (2): 212-219.

    BackgroundThe 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.MethodsA 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.ResultsThe 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.ConclusionLIA is not less effective than ISB for early postoperative pain control after TSA.Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

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