Clinical Orthopaedics and Related Research

, Volume 466, Issue 3, pp 563–572 | Cite as

Development of a Regional Model of Care for Ambulatory Total Shoulder Arthroplasty

A Pilot Study
  • S. H. Gallay
  • J. J. A. Lobo
  • J. Baker
  • K. Smith
  • K. Patel
Symposium: New Approaches to Shoulder Surgery

Abstract

Total shoulder arthroplasty (TSA) has traditionally been performed as inpatient surgery to provide adequate postoperative analgesia via intermittent opioid administration. We developed a regional model for ambulatory TSA using continuous brachial plexus nerve block (CBPNB). We asked whether this regional model would allow us to select patients to undergo outpatient TSA using CBPNB while providing similar outcomes to those patients who were managed with CBPNB and a one-night or longer inpatient hospital stay. Of 16 selected patients, eight underwent outpatient TSA/CBPNB while the other eight had an overnight hospital stay. Outcome measures included readmission, duration of CBPNB use, pain scores, adjunctive analgesia use, range of motion, and patient satisfaction. There were no readmissions. Patients used CBPNB for an average of 6 days. The average postoperative pain score was 1/10. One patient required oral analgesics while using CBPNB. All patients were very satisfied (Likert scale) and would have the surgery again. Although these data are preliminary, the development of a regional outpatient model for TSA using CBPNB permitted integration of community care and patient satisfaction and decreased length of hospital stay.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

References

  1. 1.
    Berger RA, Sanders S, D’Ambrogio E, Buchheit K, Deirmengian C, Paprosky W, Della Valle CJ, Rosenberg AG. Minimally invasive quadriceps-sparing TKA: results of a comprehensive pathway for outpatient TKA. J Knee Surg. 2006;19:145–148.PubMedGoogle Scholar
  2. 2.
    Bergogne-Berezin E. Treatment and prevention of antibiotic associated diarrhea. Int J Antimicrob Agents. 2000;16:521–526.PubMedCrossRefGoogle Scholar
  3. 3.
    Boezaart AP. Continuous interscalene block for ambulatory shoulder surgery. Best Pract Res Clin Anaesthesiol. 2002;16:295–310.PubMedCrossRefGoogle Scholar
  4. 4.
    Bryan NA, Swenson JD, Greis PE, Burks RT. Indwelling interscalene catheter use in an outpatient setting for shoulder surgery: technique, efficacy and complications. J Shoulder Elbow Surg. 2007;16:388–395.PubMedCrossRefGoogle Scholar
  5. 5.
    Canadian Institute of Health Information (CIHI) Web site. Fiscal 2005 CMG Description for Total Shoulder Replacement. Available at: http://www.cihi.ca. Accessed on 7 Sept 2007.
  6. 6.
    Capdevila X, Pirat P, Bringuier S, Gaertner E, Singelyn F, Bernard N, Choquet O, Bouaziz H, Bonnet F; French Study Group on Continuous Peripheral Nerve Blocks. Continuous peripheral nerve blocks in hospital wards after orthopedic surgery: a multicenter prospective analysis of the quality of postoperative analgesia and complications in 1,416 patients. Anesthesiology. 2005;103:1035–1045.Google Scholar
  7. 7.
    Carlsson A. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain. 1983;16:87–101.PubMedCrossRefGoogle Scholar
  8. 8.
    Cohen NP, Levine WN, Marra G, Pollock RG, Flatow EL, Brown AR, Bigliani LU. Indwelling interscalene catheter anesthesia in the surgical management of stiff shoulder: a report of 100 consecutive cases. J Shoulder Elbow Surg. 2000;9:268–274.PubMedCrossRefGoogle Scholar
  9. 9.
    Drinkwater BL. A comparison of the direction-of-perception technique with the Likert method in the measurement of attitudes. J Soc Psychol. 1965;67:189–196.PubMedCrossRefGoogle Scholar
  10. 10.
    Hutchison RW. Challenges in acute postoperative pain management. Am J Health Syst Pharm. 2007;64(6 Suppl 4):S2–S5.PubMedCrossRefGoogle Scholar
  11. 11.
    Ilfeld BM, Morey TE, Wright TW, Chidgey LK, Enneking FK. Continuous interscalene brachial plexus block for postoperative pain control at home: a randomized, double-blinded, placebo-controlled study. Anesth Analg. 2003;96:1089–1095.PubMedCrossRefGoogle Scholar
  12. 12.
    Ilfeld BM, Vandenborne K, Duncan PW, Sessler DI, Enneking FK, Shuster JJ, Theriaque DW, Chmielewski TL, Spadoni EH, Wright TW. Ambulatory continuous interscalene nerve blocks decrease the time to discharge readiness after total shoulder arthroplasty: a randomized, triple-masked, placebo-controlled study. Anesthesiology. 2006;105:999–1007.PubMedCrossRefGoogle Scholar
  13. 13.
    Ilfeld BM, Wright TW, Enneking FK, Mace JA, Shuster JJ, Spadoni EH, Chmielewski TL, Vandenborne K. Total shoulder arthroplasty as an outpatient procedure using ambulatory perineural local anesthetic infusion: a pilot feasibility study. Anesth Analg. 2005;101:1319–1322.PubMedCrossRefGoogle Scholar
  14. 14.
    Klein SM, Evans H, Nielsen KC, Tucker MS, Warner DS, Steele SM. Peripheral nerve block techniques for ambulatory surgery. Anesth Analg. 2005;101:1663–1676.PubMedCrossRefGoogle Scholar
  15. 15.
    Klein SM, Nielsen KC. Brachial plexus blocks: infusions and other mechanisms to provide prolonged analgesia. Curr Opin Anaesthesiol. 2003;16:393–399.PubMedCrossRefGoogle Scholar
  16. 16.
    Nielsen KC, Greengrass RA, Pietrobon R, Klein SM, Steele SM. Continuous interscalene brachial plexus blockade provides good analgesia at home after major shoulder surgery—report of four cases. Can J Anaesth. 2003;50:57–61.PubMedCrossRefGoogle Scholar
  17. 17.
    Russon K, Sardesai AM, Ridgway S, Whitear J, Sildown D, Boswell S, Chakrabarti A, Denny NM. Postoperative shoulder surgery initiative (POSSI): an interim report of major shoulder surgery as a day case procedure. Br J Anaesth. 2006;97:869–873.PubMedCrossRefGoogle Scholar
  18. 18.
    Salinas FV, Liu SS, Mulroy MF. The effect of single-injection femoral nerve block versus continuous femoral nerve block after total knee arthroplasty on hospital length of stay and long-term functional recovery within an established clinical pathway. Anesth Analg. 2006;102:1234–1239.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • S. H. Gallay
    • 1
  • J. J. A. Lobo
    • 1
  • J. Baker
    • 2
  • K. Smith
    • 3
  • K. Patel
    • 3
  1. 1.Department of Orthopaedic SurgeryRouge Valley Health SystemAjaxCanada
  2. 2.Department of NursingRouge Valley Health SystemAjaxCanada
  3. 3.Department of AnesthesiaRouge Valley Health SystemAjaxCanada

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