Document Detail

Joint range of motion after total shoulder arthroplasty with and without a continuous interscalene nerve block: a retrospective, case-control study.
MedLine Citation:
PMID:  16135346     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND OBJECTIVES: Although a continuous interscalene nerve block (CISB) has been shown to provide potent analgesia after major shoulder surgery, its potential effects on postoperative rehabilitation remain uninvestigated. Therefore, this retrospective case-control study was undertaken to determine the association between CISB and joint range-of-motion after total shoulder arthroplasty (TSA). METHODS: The medical records for patients who underwent TSA at our institution in the previous 3 years were examined. Each patient with a CISB (cases) was matched with a patient without a CISB (controls) for the following variables: age, gender, and TSA type (primary v revision). Data collected included maximum shoulder elevation and external rotation (primary endpoints), along with pre- and postoperative pain scores. RESULTS: Of 134 charts reviewed, 25 cases were matched with an equal number of controls. On postoperative day 1, patients with or without a CISB achieved a median (5th-95th percentiles) of 85% (51-100) and 33% (11-56) of their surgeon-defined goal for elevation (P = .048), respectively, and attained 100% (33-100) and 17% (-81-68) for external rotation (P < .001), respectively. The median numeric rating pain score (NRS) during shoulder movement for patients with CISB was 2.0 (0.0-8.7) versus 8.5 (1.8-10.0) for patients without CISB (P < .001). Least, median, and highest resting NRS for the 24 hours after surgery were 0.0 (0.0-5.8), 1.0 (0.0-6.4), and 3.0 (0.0-9.0) for patients with CISB, respectively, versus 2.0 (0.0-7.7), 6.0 (0.3-9.6), and 8.0 (0.0-10.0) for patients without CISB (P = .030, P < .001, and P < .001 between groups, respectively). CONCLUSIONS: The day after TSA, a CISB is associated with increased shoulder range of motion, most likely resulting from the potent analgesia these nerve blocks provide.
Brian M Ilfeld; Thomas W Wright; F Kayser Enneking; Timothy E Morey
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Regional anesthesia and pain medicine     Volume:  30     ISSN:  1098-7339     ISO Abbreviation:  Reg Anesth Pain Med     Publication Date:    2005 Sep-Oct
Date Detail:
Created Date:  2005-09-01     Completed Date:  2006-02-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9804508     Medline TA:  Reg Anesth Pain Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  429-33     Citation Subset:  IM    
Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254, 1600 SW Archer Road, Gainesville, FL 32610-0254, USA.
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MeSH Terms
Aged, 80 and over
Arthroplasty, Replacement / methods*,  rehabilitation
Case-Control Studies
Middle Aged
Nerve Block / methods*
Pain Measurement / methods
Pain, Postoperative / prevention & control*
Range of Motion, Articular / drug effects*,  physiology
Recovery of Function / drug effects
Retrospective Studies
Shoulder Joint / physiology,  surgery*
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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