Inter-scalene block in day-case shoulder surgery

Abstract

This study looked at the potential of using a combination of general anaesthesia and inter-scalene block (balanced anaesthesia) for providing day-case shoulder surgery services. One hundred and four patients undergoing shoulder surgery were audited using a questionnaire immediately after operation. All patients underwent shoulder surgery under a combination of general anaesthesia and inter-scalene block. The blocks were performed by a single anaesthetist experienced in the procedure. The pain scores were recorded based on visual analogue scale at 6, 12 and 48 h after operation. At 48 h overall pain control was assessed and patients were asked their opinion about having their operation done as a day-case. There were 52 males and 52 females with mean age of 49 years (range 18–85). Mean operation time was 47 min (range 25–90). Ninety-seven (93%) patients were pain free immediately after the operation. Seventy-six (73%) patients were pain free at 6 h and 39 (38%) at 12 h. Mean pain scores at 6 h was 3 and at 12 h was 4. One hundred and one patients said their pain was well controlled throughout the first 48 h by simple oral analgesics. Eighty-four (83%) patients expressed the opinion that they could have been managed as day case provided they were adequately counselled about the procedure. Six (5.7%) patients showed signs of Horner’s syndrome that resolved by 12 h. No other complications related to inter-scalene block occurred. This study has shown that inter-scalene block is a safe procedure providing sustained adequate pain relief after shoulder surgery. It could allow a high percentage of patients undergoing shoulder surgery to be discharged home on the day of the surgery.

Résumé

Cette étude met en évidence le bénéfice d’une anesthésie balancée (association d’un bloc interscalénique et d’une anesthésie générale) dans la chirurgie ambulatoire de l’épaule dans un groupe de 104 patients. Dans la période post opératoire, 98% des patients ont été soulagés, tandis que 83% d’entre eux ont pu sortir le jour même de l’hôpital. Aucune complication grave n’a été notée. Les auteurs concluent que le bloc interscalénique est une technique analgésique sûre qui peut permettre de réaliser la chirurgie arthroscopique de l’épaule en ambulatoire.