Erector spinae plane block vs. peri-articular injection for pain control after arthroscopic shoulder surgery: a randomised controlled trial

H Shanthanna, M Czuczman, P Moisiuk, T O'Hare, M Khan, M Forero, K Davis, J Moro, T Vanniyasingam, G Foster, L Thabane, B Alolabi, H Shanthanna, M Czuczman, P Moisiuk, T O'Hare, M Khan, M Forero, K Davis, J Moro, T Vanniyasingam, G Foster, L Thabane, B Alolabi

Abstract

Interscalene brachial plexus block is the standard regional analgesic technique for shoulder surgery. Given its adverse effects, alternative techniques have been explored. Reports suggest that the erector spinae plane block may potentially provide effective analgesia following shoulder surgery. However, its analgesic efficacy for shoulder surgery compared with placebo or local anaesthetic infiltration has never been established. We conducted a randomised controlled trial to compare the analgesic efficacy of pre-operative T2 erector spinae plane block with peri-articular infiltration at the end of surgery. Sixty-two patients undergoing arthroscopic shoulder repair were randomly assigned to receive active erector spinae plane block with saline peri-articular injection (n = 31) or active peri-articular injection with saline erector spinae plane block (n = 31) in a blinded double-dummy design. Primary outcome was resting pain score in recovery. Secondary outcomes included pain scores with movement; opioid use; patient satisfaction; adverse effects in hospital; and outcomes at 24 h and 1 month. There was no difference in pain scores in recovery, with a median difference (95%CI) of 0.6 (-1.9-3.1), p = 0.65. Median postoperative oral morphine equivalent utilisation was significantly higher in the erector spinae plane group (21 mg vs. 12 mg; p = 0.028). Itching was observed in 10% of patients who received erector spinae plane block and there was no difference in the incidence of significant nausea and vomiting. Patient satisfaction scores, and pain scores and opioid use at 24 h were similar. At 1 month, six (peri-articular injection) and eight (erector spinae plane block) patients reported persistent pain. Erector spinae plane block was not superior to peri-articular injection for arthroscopic shoulder surgery.

Keywords: acute pain; erector spinae plane block; opioid use; peri-articular injection; shoulder surgery.

© 2021 Association of Anaesthetists.

References

    1. Chung F, Ritchie E, Su J. Postoperative pain in ambulatory surgery. Anesthesia and Analgesia 1997; 85: 808-16.
    1. Fontana C, Di Donato A, Di Giacomo G, et al. Postoperative analgesia for arthroscopic shoulder surgery: a prospective randomized controlled study of intraarticular, subacromial injection, interscalenic brachial plexus block and intraarticular plus subacromial injection efficacy. European Journal of Anaesthesiology 2009; 26: 689-93.
    1. Singelyn FJ, Lhotel L, Fabre B. Pain relief after arthroscopic shoulder surgery: a comparison of intraarticular analgesia, suprascapular nerve block, and interscalene brachial plexus block. Anesthesia and Analgesia 2004; 99: 589-92.
    1. Toma O, Persoons B, Pogatzki-Zahn E, et al. PROSPECT guideline for rotator cuff repair surgery: systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia 2019; 74: 1320-31.
    1. Shin SW, Byeon GJ, Yoon JU, et al. Effective analgesia with ultrasound-guided interscalene brachial plexus block for postoperative pain control after arthroscopic rotator cuff repair. Journal of Anesthesia 2014; 28: 64-9.
    1. Candido KD, Sukhani R, Doty R, et al. Neurologic sequelae after interscalene brachial plexus block for shoulder/upper arm surgery: the association of patient, anesthetic, and surgical factors to the incidence and clinical course. Anesthesia and Analgesia 2005; 100: 1489-95.
    1. Abdallah FW, Halpern SH, Aoyama K, Brull R. Will the real benefits of single-shot interscalene block please stand up? A systematic review and meta-analysis. Anesthesia and Analgesia 2015; 120: 1114-29.
    1. Yung EM, Got TC, Patel N, Brull R, Abdallah FW. Intra-articular infiltration analgesia for arthroscopic shoulder surgery: a systematic review and meta-analysis. Anaesthesia 2021; 76: 549-58.
    1. Gross BD, Paganessi SA, Vazquez O. Comparison of subacromial injection and interscalene block for immediate pain management after arthroscopic rotator cuff repair. Arthroscopy 2020; 36: 1243-50.
    1. Saito M, Tsukada S, Fujita N, et al. Post-operative pain control following arthroscopic rotator cuff repair: peri-articular injection versus interscalene brachial plexus block. International Orthopaedics 2019; 43: 1435-41.
    1. Harvey GP, Chelly JE, AlSamsam T, Coupe K. Patient-controlled ropivacaine analgesia after arthroscopic subacromial decompression. Arthroscopy 2004; 20: 451-5.
    1. Warrender WJ, Syed UAM, Hammoud S, et al. Pain management after outpatient shoulder arthroscopy: a systematic review of randomized controlled trials. American Journal of Sports Medicine 2017; 45: 1676-86.
    1. Uquillas CA, Capogna BM, Rossy WH, Mahure SA, Rokito AS. Postoperative pain control after arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery 2016; 25: 1204-13.
    1. Saadawi M, Layera S, Aliste J, Bravo D, Leurcharusmee P, Tran Q. Erector spinae plane block: a narrative review with systematic analysis of the evidence pertaining to clinical indications and alternative truncal blocks. Journal of Clinical Anesthesia 2021; 68: 110063.
    1. Chin KJ, El-Boghdadly K. Mechanisms of action of the erector spinae plane (ESP) block: a narrative review. Canadian Journal of Anesthesia 2021; 68: 387-408.
    1. Forero M, Rajarathinam M, Adhikary SD, Chin KJ. Erector spinae plane block for the management of chronic shoulder pain: a case report. Canadian Journal of Anesthesia 2018; 65: 288-93.
    1. Selvi O, Tulgar S, Ozer Z. Case report presentation of ultrasound-guided erector spinae plane block in shoulder surgery: three patients and two different results. Cureus 2018; 10: e3538.
    1. Czuczman M, Shanthanna H, Alolabi B, et al. Randomized control trial of ultrasound-guided erector spinae block versus shoulder peri-articular anesthetic infiltration for pain control after arthroscopic shoulder surgery: Study protocol clinical trial (SPIRIT compliant). Medicine (Baltimore) 2020; 99: e19721.
    1. Bijur PE, Latimer CT, Gallagher EJ. Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department. Academic Emergency Medicine 2003; 10: 390-2.
    1. Cooper SA, Desjardins PJ, Turk DC, et al. Research design considerations for single-dose analgesic clinical trials in acute pain: IMMPACT recommendations. Pain 2016; 157: 288-301.
    1. Aliste J, Bravo D, Fernandez D, Layera S, Finlayson RJ, Tran DQ. A randomized comparison between interscalene and small-volume supraclavicular blocks for arthroscopic shoulder surgery. Regional Anesthesia and Pain Medicine 2018; 43: 590-5.
    1. American Thoracic Society/European Respiratory Society. ATS/ERS Statement on respiratory muscle testing. American Journal of Respiratory and Critical Care Medicine 2002; 166: 518-624.
    1. Merivirta R, Kuusniemi KS, Aantaa R, Hurme SA, Aärimaa V, Leino KA. The analgesic effect of continuous subacromial bupivacaine infusion after arthroscopic shoulder surgery: a randomized controlled trial. Acta Anaesthesiologica Scandinavica 2012; 56: 210-6.
    1. Floyd WF, Silver PH. The function of the erectores spinae muscles in certain movements and postures in man. Journal of Physiology 1955; 129: 184-203.
    1. Vanderbilt University Department of Biostatistics. PS: power and sample size calculation. 2021. (accessed 01/10/2021).
    1. Bohaczuk S, Pai P. How I do it: regional anesthesia for shoulder surgery. 2020. (accessed 01/10/2021).
    1. Nair A, Diwan S. Erector spinae block as a phrenic nerve sparing block for shoulder surgeries. Regional Anesthesia and Pain Medicine 2020; 45: 751-2.
    1. Tran Q, Layera S, Bravo D, Cristi-Sánchez I, Bermúdez L, Aliste J. Slam dunk or air ball? Regional Anesthesia and Pain Medicine 2021; 46: 288-9.
    1. . ESP for Shoulder Surgeries. 2021 (accessed 04/02/2021).
    1. Sun LBS, Gerber L, Tsui BCH. Erector spinae plane block for total shoulder arthroplasty avoids phrenic nerve complication: a randomized trial. 45th Annual Regional Anesthesiology And Acute Pain Medicine (ASRA) meeting San Francisco, 2020: Abstract 790. * (accessed 26/10/2021).
    1. Elsharkawy H, Ince I, Hamadnalla H, Drake RL, Tsui BCH. Cervical erector spinae plane block: a cadaver study. Regional Anesthesia and Pain Medicine 2020; 45: 552-6.
    1. Ciftci B, Ekinci M, Gölboyu BE, et al. High thoracic erector spinae plane block for arthroscopic shoulder surgery: a randomized prospective double-blind study. Pain Medicine 2021; 22: 776-83.
    1. Barreveld A, Witte J, Chahal H, Durieux ME, Strichartz G. Preventive analgesia by local anesthetics: the reduction of postoperative pain by peripheral nerve blocks and intravenous drugs. Anesthesia and Analgesia 2013; 116: 1141-61.
    1. Hermanns H, Hollmann MW, Stevens MF, et al. Molecular mechanisms of action of systemic lidocaine in acute and chronic pain: a narrative review. British Journal of Anaesthesia 2019; 123: 335-49.
    1. Gadsden J. The erector spinae plane block: the case of the elusive mechanism of action. Canadian Journal of Anesthesia 2021; 68: 288-92.
    1. Black ND, Stecco C, Chan VWS. Fascial plane blocks: more questions than answers? Anesthesia and Analgesia 2021; 132: 899-905.
    1. Boezaart AP. That which we call a rose by any other name would smell as sweet-and its thorns would hurt as much. Regional Anesthesia and Pain Medicine 2009; 34: 3-7.

Source: PubMed

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