Disclosures: The authors report no relevant financial disclosures.
December 30, 2021
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Peripheral nerve blocks may effectively reduce pain after arthroscopic rotator cuff repair

Disclosures: The authors report no relevant financial disclosures.
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According to published results, peripheral nerve blocks may effectively reduce postoperative pain in patients undergoing arthroscopic rotator cuff repair and may be an alternative to general anesthesia alone.

To compare the effectiveness of peripheral nerve blocks and general anesthesia (GA) in for postoperative pain, Andrew Kalthoff, DO, and colleagues performed a systematic review of 14 randomized controlled trials, which included 851 patients who underwent arthroscopic rotator cuff repair (ARCR) from Jan. 1, 2005 to Feb. 16, 2021. The primary outcome was numeric rating scale (NRS) or VAS pain scores at 1 hour, 24 hours and 48 hours after surgery.

In total, six different nerve block interventions were included in the review: single-shot interscalene brachial plexus nerve block (s-ISB), single-shot suprascapular nerve block (s-SSNB), continuous ISB, continuous SSNB, s-ISB combined with SSNB and s-SSNB combined with axillary nerve block.

After meta-analysis, Kalthoff and colleagues found the continuous ISB had a “significant reduction” in pain scores compared with GA at 1-hour after surgery; however, there were no significant differences in pain scores at 24 hours and 48 hours after surgery. They also noted the s-ISB combined with SSNB had a “significant reduction” in 48-hour pain scores compared with s-ISB alone.

“It remains unclear which peripheral nerve block strategy is optimal for ARCR,” Kalthoff and colleagues wrote in the study. “However, peripheral nerve blocks are highly effective at attenuating postoperative ARCR pain and should be more widely considered as an alternative over general anesthesia alone,” they wrote.