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Anesth Analg 2008; 106:991-996
© 2008 International Anesthesia Research Society
doi: 10.1213/ane.0b013e31816151ab
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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{ddagger}, Peter Conzen, MD*, and Dirk Schwender, MD{dagger}

From the *Clinic of Anesthesiology/Critical Care Medicine and Pain Therapy (M.A.B., P.C.), Ludwig-Maximilians-University, City of Munich, Germany; {dagger}Department of Anesthesia, Municipal Hospital Friedrichshafen, City of Friedrichshafen, Germany; and {ddagger}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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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2008 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2008 by the International Anesthesia Research Society.