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Does continuous interscalene nerve blockage delay discharge following minimal invasive shoulder surgery?

29 Sep 2013

Background: When compared with single shot interscalene nerve blockade (SSISB), continuous interscalene nerve blockade (CISNB) has previously been shown to decrease pain and narcotic requirement following open shoulder surgery including arthroplasty and rotator cuff repair. Advances in surgery have allowed many shoulder operations to be performed arthroscopically or via a “mini open” approach. This study investigates whether continuous nerve blockade provides a difference in recovery parameters sufficient to impact discharge time following surgery when compared with a single dose nerve block.

Methods: This was a retrospective case-control series. The hospital records of consecutive arthroscopic or mini open shoulder operation patients were examined and divided into those given CISNB (n = 94) and those given SSISB (n = 77) for post operative analgesia. Groups were compared for time to discharge in a private hospital setting in which strict discharge protocols were not in place. Narcotic use and maximal visual analogue scale (VAS) pain score were also recorded.

Results: Length of stay was statistically significantly different between the two groups. Patients in the CISNB group had a median length of stay of 24.5 hours (IQR 20.8-42.0) compared to 23.0 hours (18.8-40.5) in the SSISB group (p = .03). CISNB group patients had decreased narcotic use. No difference in maximal VAS pain score was identified.

Conclusion: With greater emphasis on non-invasive approaches to shoulder surgery, patients are able to be discharged at a time acceptable to both physician and patient regardless of the presence of CISNB. Surprisingly the CISNB group had a longer length of stay (although from a practical sense similar). The advantages of this analgesic technique in terms of improved pain relief and decreased narcotic use do not affect hospital length of stay. Level III evidence.

29 September 2013

Click here to view the full article which appeared in Journal of Hospital Administration