Clinical Orthopaedics and Related Research®

, Volume 472, Issue 5, pp 1482–1488

Peripheral Nerve Blocks in Shoulder Arthroplasty: How Do They Influence Complications and Length of Stay?

  • Ottokar Stundner
  • Rehana Rasul
  • Ya-Lin Chiu
  • Xuming Sun
  • Madhu Mazumdar
  • Chad M. Brummett
  • Reinhold Ortmaier
  • Stavros G. Memtsoudis
Symposium: Perioperative Pain Management in Orthopaedic Surgery

DOI: 10.1007/s11999-013-3356-1

Cite this article as:
Stundner, O., Rasul, R., Chiu, YL. et al. Clin Orthop Relat Res (2014) 472: 1482. doi:10.1007/s11999-013-3356-1

Abstract

Background

Regional anesthesia has proven to be a highly effective technique for pain control after total shoulder arthroplasty. However, concerns have been raised about the safety of upper-extremity nerve blocks, particularly with respect to the incidence of perioperative respiratory and neurologic complications, and little is known about their influence, if any, on length of stay after surgery.

Questions/purposes

Using a large national cohort, we asked: (1) How frequently are upper-extremity peripheral nerve blocks added to general anesthesia in patients undergoing total shoulder arthroplasty? (2) Are there differences in the incidence of and adjusted risk for major perioperative complications and mortality between patients receiving general anesthesia with and without nerve blocks? And (3) does resource utilization (blood product transfusion, intensive care unit admission, length of stay) differ between groups?

Methods

We searched a nationwide discharge database for patients undergoing total shoulder arthroplasty under general anesthesia with or without addition of a nerve block. Groups were compared with regard to demographics, comorbidities, major perioperative complications, and length of stay. Multivariable logistic regressions were performed to measure complications and resource use. A negative binomial regression was fitted to measure length of stay.

Results

We identified 17,157 patients who underwent total shoulder arthroplasty between 2007 and 2011. Of those, approximately 21% received an upper-extremity peripheral nerve block in addition to general anesthesia. Patients receiving combined regional-general anesthesia had similar mean age (68.6 years [95% CI: 68.2–68.9 years] versus 69.1 years [95% CI: 68.9–69.3 years], p < 0.0043), a slightly lower mean Deyo (comorbidity) index (0.87 versus 0.93, p = 0.0052), and similar prevalence of individual comorbidities, compared to those patients receiving general anesthesia only. Addition of regional anesthesia was not associated with different odds ratios for complications, transfusion, and intensive care unit admission. Incident rates for length of stay were also similar between groups (incident rate ratio = 0.99; 95% CI: 0.97–1.02; p = 0.467)

Conclusions

Addition of regional to general anesthesia was not associated with an increased complication profile or increased use of resources. In combination with improved pain control as known from previous research, regional anesthesia may represent a viable management option for shoulder arthroplasty. However, further research is necessary to better clarify the risk of neurologic complications.

Level of Evidence

Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Supplementary material

11999_2013_3356_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 14 kb)

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Ottokar Stundner
    • 1
  • Rehana Rasul
    • 2
  • Ya-Lin Chiu
    • 2
  • Xuming Sun
    • 2
  • Madhu Mazumdar
    • 2
  • Chad M. Brummett
    • 3
  • Reinhold Ortmaier
    • 4
  • Stavros G. Memtsoudis
    • 5
  1. 1.Department of Anesthesiology, Perioperative Medicine and Intensive CareParacelsus Medical UniversitySalzburgAustria
  2. 2.Division of Biostatistics and Epidemiology, Department of Public HealthWeill Medical College of Cornell UniversityNew YorkUSA
  3. 3.Department of AnesthesiologyUniversity of Michigan Health SystemAnn ArborUSA
  4. 4.Department of Trauma SurgeryParacelsus Medical UniversitySalzburgAustria
  5. 5.Department of Anesthesiology, Hospital for Special SurgeryWeill Medical College of Cornell UniversityNew YorkUSA