This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Macfarlane, A. J. R. Articles by Brull, R. Search for Related Content PubMed PubMed Citation Articles by Macfarlane, A. J. R. Articles by Brull, R.

---

LETTER TO THE EDITOR

Continuous Interscalene Block for Open Shoulder Surgery

Department of Anesthesia and Pain Management; Toronto Western Hospital; University of Toronto; Toronto, Canada; a_m_macfarlane{at}hotmail.com

To the Editor:

Hofmann-Kiefer et al.1 recently confirmed that continuous patient controlled interscalene block (PCISB) can reduce pain after open shoulder surgery compared with IV patient controlled analgesia. In contrast, however, to previous work by Ilfeld2 and Capdevila,3 functional ability was not improved. Admittedly, the types of shoulder surgery and outcome measures were different between the studies, but we question whether the quality of the block in Hofmann-Kiefer’s study contributed to their equivocal result. Despite reporting a zero incidence of incomplete blocks preoperatively, the mean dose of intraoperative fentanyl required in the PCISB group was curiously large (260 µg). In addition, a significant proportion of patients in the PCISB group were not analyzed either because of catheter dislocation or removal, or postoperative dyspnea. Combined with the fact that certain investigators were unblinded, the lack of "intention to treat" analysis may have skewed results in favor of the PCISB group. The rate of catheter dislodgement reported in Hofmann-Kiefer’s study (approximately 20%) is unacceptably high and could likely have been reduced by tunneling4 or using glue.5 Further investigation is required to confirm whether or not PCISB can confer early functional improvement and, importantly, whether this actually translates into long-term benefit.

REFERENCES

1. Hofmann-Kiefer K, Eiser T, Chappell D, Leuschner S, Conzen P, Schwender D. Does patient-controlled interscalene block improve early functional rehabilitation after open shoulder surgery. Anesth Analg 2008;106:991–6[Abstract/Free Full Text]
2. Ilfeld BM, Vandenborne K, Duncan PW, Sessler DI, Enneking FK, Shuster JJ, Theriaque DW, Chmielewski TL, Spadoni EH, Wright TW. Ambulatory continuous interscalene nerve blocks decrease the time to discharge readiness after total shoulder arthroplasty: a randomized, triple-masked, placebo-controlled study. Anesthesiology 2006;105:999–1007[Web of Science][Medline]
3. Capdevila X, Dadure C, Bringuier S, Bernard N, Biboulet P, Gaertner E, Macaire P. Effect of patient-controlled perineural analgesia on rehabilitation and pain after ambulatory orthopedic surgery: a multicenter randomized trial. Anesthesiology 2006;105:566–73[Web of Science][Medline]
4. Ekatodramis G, Borgeat A. Subcutaneous tunnelling of the interscalene catheter. Can J Anaesth 2000;47:716–17[Web of Science][Medline]
5. Bloc S, Garnier T, Mercidal L, Roy M, Dhonneur G. Evaluation of synthetic glue for the fixation of continuous peripheral nerve catheters. Ann Fr Anesth Reanim 2008;1:103–5

This article has been cited by other articles:

				K. F. Hofmann-Kiefer, T. Eiser, D. Chappell, S. Leuschner, P. Conzen, and D. Schwender Continuous Interscalene Block for Open Shoulder Surgery Anesth. Analg., August 1, 2008; 107(2): 726 - 727. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Macfarlane, A. J. R. Articles by Brull, R. Search for Related Content PubMed PubMed Citation Articles by Macfarlane, A. J. R. Articles by Brull, R.