Regional anaesthesia for surgical repair of proximal humerus fractures: a systematic review and critical appraisal
Regional anaesthesia (RA) is often used in shoulder surgery because it provides adequate postoperative analgesia and may enhance the patient outcome. RA reduces overall opioid consumption and is frequently used in enhanced recovery programs to decrease hospital stay. However, there is very limited literature confirming these advantages in the surgical repair of proximal humerus fractures. This paper reviews the current literature on the use of RA in pain management after surgical repair of these fractures and evaluates the effect of RA on the functional outcome, length of stay in hospital, and health care expenditure.
Materials and methods
The PubMed, Embase, Web of Science, and Cochrane Library databases were searched up to March 1, 2018. Studies investigating the use of RA in the management of proximal humerus fractures were included.
Eleven studies (containing 1872 patients) were eligible for inclusion. The analgesic effect of RA was investigated in eight studies that confirmed its pain-relieving ability. Two studies measured functionality and length of hospitalization and suggested that RA improved function and shortened the stay in hospital. Nine papers mentioned side effects associated with RA while three articles claim that RA decreases the incidence of adverse events associated with general anaesthesia.
This systematic review suggests that RA is a good option for postoperative analgesia in patients undergoing surgical repair of a proximal humerus fracture and is associated with fewer adverse events, a shorter recovery time, and a better functional outcome than those achieved by general anaesthesia alone. However, given the limited amount of data available, conclusions need to be made with caution and prospective studies are needed in the future.
KeywordsSystematic review Proximal humerus fractures Regional anaesthesia Postoperative outcome Peripheral nerve block
Interscalene nerve block
Enhanced recovery programs
Length of stay
Randomized controlled trials
Postoperative nausea and vomiting
Disabilities of the arm, shoulder, and hand
Post-anaesthesia care unit
The authors thank Mr. Thomas Vandendriessche, biomedical information specialist (KU Leuven Libraries-2 Bergen-Learning Centre Désiré Collen, Leuven, Belgium), for his help in conducting the systematic literature search.
No funding was received.
Compliance with ethical standards
Conflict of interest
Prof. Dr. An Sermon is a consultant for DepuySynthes. Prof. Dr. Willem-Jan Metsemakers is a consultant for DepuySynthes and BoneSupport. Furthermore, he is a member of the lecture bureau of Zimmer Biomet. Prof. Dr. Stefaan Nijs is consultant for DepuySynthes, Zimmer Biomet and Mathys Medical. Prof. Dr. Harm Hoekstra is a member of the lecture bureau of DepuySynthes and 7Smedical. All authors hereby disclose any financial and personal relationships with other people or organisations that could inappropriately influence this work.
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