We are still unclear about the patterns of outcome in patient safety, comfort and satisfaction while using regional anesthesia and its correlation to the functional outcome of the surgery and so we have tried to understand the safety and effectiveness of regional anaesthesia in arthroscopic procedures of the shoulder.
Arthroscopic shoulder procedures are popularly done using general and regional anaesthesia. Though a number of studies compare the merits and demerits of both the types of anaesthesia, we are still unclear about the patterns of outcome in patient safety, comfort and satisfaction while using regional anaesthesia and its correlation to the functional outcome of the surgery. In our study, we have tried to understand the safety and effectiveness of regional anaesthesia in arthroscopic procedures of the shoulder.
1.To determine the preoperative variables in a patient which are associated with increased postoperative pain and discomfort 2. To determine the “red flags” in a patient to avoid regional anaesthesia in shoulder arthroscopy 3. To determine whether the functional outcome of the surgery corelated with the preoperative variables.
Our study comprised 181 consecutive patients who underwent Arthroscopic shoulder procedures under regional anesthesia (interscalene brachial plexus block). All were performed by a single operating surgeon in the beach chair position.
Preoperatively patients were evaluated for variables like anxiety (using the State-Trait Anxiety Inventory), preoperative analgesic dependence, alcohol dependence, comorbidities, and the shoulder function by the UCLA shoulder rating scale.
Intraoperatively patients were monitored for physiological measures of pain like pulse rate, respiratory rate and for regional anaesthesia complications of Vasovagal episode, Horner’s syndrome, hemidiaphragmatic palsy, systemic toxicity and block failure.
Patient’s pain was assessed by the Visual Analog Score at hours 0,2,4,6,8,10 after the surgery. Patients were interviewed regarding their comfort level during the surgery.The functional outcome was evaluated with the UCLA shoulder rating scale at three and six months after surgery. The time taken to return to normal work was assessed.
Among the 181 patients, 91 underwent rotator cuff repair,59 underwent labral repair,20 underwent Subacromial decompression and acromioplasty and 11 underwent capsular release.
24 patients had severe pain and discomfort during the surgery and required sedation(Ramsay sedation scale C)3 patients required conversion to General Anaesthesia.
Correlation coefficients and scatter plots were used to determine if the preoperative variables were correlated to the patients with high pain score and discomfort. With regard to the preoperative variables, patients with high pain score and discomfort were more likely to have been anxious, consuming analgesics before surgery than the patients with a normal pain score. No correlation existed between the postoperative pain score and the physiologic parameters of pain, existing comorbidities or age.
The time taken to return to routine work was also higher in patients with high pain score and discomfort. However, the functional outcome of the surgery (determined by descriptive statistics; paired t test) at six months had no correlation to the pain score, comfort level, comorbidities of the patient.
Isolated regional anesthesia in shoulder arthroscopy has several advantages which include ease of administration, safety in the elderly and with comorbidities, doctor-patient interaction during the procedure, early recovery. However, patients with anxiety and claustrophobia, preoperative analgesic dependence, alcohol dependence should be taken up with caution.