Shoulder Pain
Conditions
Keywords
Shoulder surgery, pain, suprascapular block
Brief summary
Shoulder surgery is performed usually under interscalene block considered as a gold standard. This anesthesia is well suited for hospitalized patients but not for outpatients. The Orthopedic Surgery Department of Clinique Chénieux has been operating patients requiring arthroscopic shoulder surgery with a short interscalene block relayed by a long suprascapular block. The main objective is to evaluate the effectiveness of this method by measuring the average pain over 3 days after the operation.
Detailed description
The surgery of the shoulder is usually performed under interscalene block (ISB), considered as a gold standard. This anesthesia is well suited for hospitalized patients but not for outpatients. Indeed, the ISB entails, in addition to a sensory block, a motor block often useless and important since it extends beyond the shoulder to the entire upper limb. It can also be a source of anxiety and cause the risk of compression in the limb operated because of the extended sensorimotor block. It is also responsible for a painful bounce almost constant with sometimes the very rapid installation of intense pain when the effect of the sensory block disappears. This pain can be difficult to relieve despite frequent use of opioids. The Orthopedic and Traumatologic Surgery Department of the Clinique Chénieux has been operating patients requiring arthroscopic surgery of the shoulder according to the following technique. It involves the establishment of a short ISB (between 2h and 4h) relayed by a supra-scapular block (SSB) long (72h) through the placement of a perineural catheter thus allowing a continuous diffusion of Naropein® by an elastomeric pump. The same day or the day after the operation, the patients return to their home and are followed by nurses. The objective of this technique is to better manage postoperative pain, thus allowing the management of patients in outpatient surgery. A prospective non-interventional study will make it possible, in a context of common practice, to obtain data on the management of pain in operated patients and then to consider a generalization of this practice to other centers.
Interventions
None listed
Sponsors
Clinique chénieux
University Hospital, Limoges
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Inclusion criteria
* Men, women between 18 and 70 years * Patient in need of acromioplasty or rotator cuff surgery (ruptured cuff or calcification of the cuff) or reinsertion of the glenoid bead (Bankart intervention) * Patient with an American Society of Anesthesiologists score (ASA) of 1 or 2
Exclusion criteria
* Patient needing shoulder surgery for other indications and open surgery * Patient with cognitive impairment or dementia symptoms * Patient with a BMI ≥ 35 without systemic morbidity requiring hospitalization * Contraindication to the drugs used in the study (hypersensitivity to ropivacaine or other amide-bonded local anesthetics) * Pregnant or lactating patient * Patient with severe hepatic impairment * Class III antiarrhythmic patient
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Average of pain | Day1 | Score of average pain at D1, D2 and D3 by a numeric pain scale (NPS) \<4/10 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of painful peaks | Day 0 | Number of painful peaks on awakening and leaving the block on the day of the operation |
| Analgesics consummation | Day 1, Day 2, Day 3, Day 4 and Day 7 | Amount and types of analgesics consumed / consumed non-opioid during the operation and the first week after the operation |
| Score of Pain | Day 4, Day 7, Day 15 and Day 30 | Score of minimum, maximum, average pain the month before the operation and by a numeric pain scale (NPS). Scale from 0 to 10. |
| Number of readmissions | Day 7 | Number of readmissions the first week after the operation |
| Number of postoperative complications | Month 3 | Number of postoperative complications at 3 month |
| Cartilaginous Toxicology | Month 6 and Month 12 | Cartilaginous Toxicology at 6 months and 12 months determined by radiograph of the shoulder of face in 3 rotations |
| Satisfied patient rate | Day 30 | Satisfied patient rate determined by using a satisfaction questionnaire with 4 responses: very satisfied, somewhat satisfied, somewhat dissatisfied and very dissatisfied |
Countries
France
Outcome results
None listed