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Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 12, pp 1731–1741 | Cite as

Regional anaesthesia for surgical repair of proximal humerus fractures: a systematic review and critical appraisal

  • Jorien IliaensEmail author
  • Willem-Jan Metsemakers
  • Steve Coppens
  • Harm Hoekstra
  • An Sermon
  • Marc Van de Velde
  • Stefaan Nijs
Trauma Surgery

Abstract

Introduction

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.

Results

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.

Conclusions

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.

Keywords

Systematic review Proximal humerus fractures Regional anaesthesia Postoperative outcome Peripheral nerve block 

Abbreviations

RA

Regional anaesthesia

ISB

Interscalene nerve block

ERPs

Enhanced recovery programs

LOS

Length of stay

RCTs

Randomized controlled trials

GA

General anaesthesia

PONV

Postoperative nausea and vomiting

DASH

Disabilities of the arm, shoulder, and hand

PACU

Post-anaesthesia care unit

Notes

Acknowledgements

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.

Funding

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.

Supplementary material

402_2019_3253_MOESM1_ESM.docx (16 kb)
Supplementary file1 (DOCX 16 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Trauma SurgeryUniversity Hospitals LeuvenLeuvenBelgium
  2. 2.Department of AnaesthesiologyUniversity Hospitals LeuvenLeuvenBelgium
  3. 3.Department of Development and RegenerationKU Leuven, University of LeuvenLeuvenBelgium

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