Regional Anesthesia for Pain Control in Arthroscopic Shoulder Stabilization

Background:
Regional anesthesia (RA) is standard of care in many orthopedic operations and the indications to its use are increasing and constantly being studied. Regional anesthesia and specifically the inter scalene brachial plexus nerve block (ISB) is commonly used for early postoperative pain control in shoulder arthroscopy, but its use is based mainly on literature examining rotator cuff repair surgeries. This study aimed to investigate the effectiveness of ISB specifically in arthroscopic shoulder stabilization surgeries.

Methods:
All adult patients who underwent arthroscopic shoulder stabilization for anterior shoulder instability between the years 2010-2021 were located. Demographic and medical data (age, sex, BMI, ASA score), method of anesthesia and early post-operative pain related outcomes were collected. Pain levels, perioperative opioid use and total OR time were compared between patients treated with general anesthesia (GA) alone and patients treated with GA+ interscalene brachial plexus nerve block (ISB).

Results:
132 patients treated with GA+ISB and 433 patients treated with GA alone were included. There were no significant differences between the groups in age, sex, ASA score and BMI. Pain numerical rating Scale (NRS) levels in the GA+ISB group were significantly lower than in the GA group (0.6 vs 2.2 on admission to post anesthesia care unit (PACU), p<0.001, 0.3 vs 0.9 at PACU discharge, P

Conclusions:
ISB is effective in pain and opioid administration reduction and in prevention of severe pain in the early postoperative period, however, total OR time increased by 32 minutes. Performing the ISB before entering the OR and possibly administering it as an alternative rather than addition to GA will may increase its benefits and cost-effectiveness.