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REGIONAL ANESTHESIA

Does Patient-Controlled Continuous Interscalene Block Improve Early Functional Rehabilitation After Open Shoulder Surgery?

Klaus Hofmann-Kiefer, MD^*, Tim Eiser, MD^*, Daniel Chappell, MD^*, Stephan Leuschner, MD, Peter Conzen, MD^*, and Dirk Schwender, MD

From the *Clinic of Anesthesiology/Critical Care Medicine and Pain Therapy (M.A.B., P.C.), Ludwig-Maximilians-University, City of Munich, Germany; Department of Anesthesia, Municipal Hospital Friedrichshafen, City of Friedrichshafen, Germany; and Department of Anesthesia, Municipal Hospital Luebeck, City of Luebeck, Germany.

Address correspondence to Dr. Klaus Hofmann-Kiefer, Klinik für Anästhesiologie der Ludwig-Maximilians-Universität München, Klinikum Innenstadt, Maistr. 11, D-80337 München, Germany. Address e-mail to klaus.hofmann-kiefer{at}med.uni-muenchen.de.

BACKGROUND: Early mobilization after shoulder surgery plays a vital role in successful functional rehabilitation. However, postoperative pain often reduces, or even prevents, effective physiotherapy. We investigated the effect of analgesia via patient-controlled interscalene technique on early functional rehabilitation after open shoulder surgery.

METHODS: Eighty-seven patients were randomly assigned to one of two groups: patient-controlled continuous interscalene block (PCISB) and patient-controlled IV (opioid) analgesia (PCA). Interscalene block was performed preoperatively; otherwise analgesic protocols were started in the postanesthesia care unit and were continued for 72 h. Physiotherapy was performed for 60 min a day on day 2 and 3 after surgery according to a standardized protocol. Maximum mobility was defined as the range of motion that could be achieved with pain as the limiting factor. Efficiency of functional rehabilitation was evaluated 1 day before and 3 days after surgery with the help of a multimodal scoring system (Constant-Score) that evaluates pain, daily life activity, strength and range of motion. Maximum intensity of pain was also monitored via Visual Analog Scales for the first 72 h after surgery and during in-hospital physiotherapy.

RESULTS: Constant-Score rates were significantly improved by the interscalene block. However, no significant differences in mobility and strength sub-scores were observed between the groups. Compared with PCA, PCISB proved to be beneficial concerning pain at rest at 6 h (P < 0.001), 24 h (P = 0.044), and 72 h (P = 0.013) and for pain during physiotherapy at 48 h after surgery (P = 0.016).

CONCLUSION: Compared with opioid-based PCA, PCISB improved analgesia, but not function, during early rehabilitation of the shoulder joint.

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