INTRA-BURSAL VERSUS INTER-SCALENE POST-OPERATIVE PAIN CONTROL FOR ARTHROSCOPIC SHOULDER SURGERY

Abstract

Background Various methods of analgesia have been described for shoulder surgery, and we routinely used inter-scalene analgesia. We hypothesised that inter-scalene analgesia provided better pain control than intra-bursal analgesia.

Methods We prospectively collected data over a consecutive two year period, with the first year patients (n=65) all having inter-scalene and the second year patients (n=79) having intra-bursal catheters. The interscalene 16F catheters were placed with the patient anaesthetised and an electrical Touhy needle. The intra-bursal 16F catheters were placed at the end of the arthroscopic shoulder operation, under direct vision, exiting from the posterior portal. Pain parameters collected were pain scores, visual analogue scales, analgesia useage, and whether or not the patients were comfortably able to go home the same day as surgery.

Results Pain and visual analogue scores showed no statistical differences between the two groups. Analgesia useage was greater in the inter-scalene group than the intra-bursal group, but was not statistically different. 32/65 (49%) of patients with inter-scalene catheters and 75/79 (95%) of patients with intra-bursal catheters were able to comfortably go home on the day of surgery, 28/33 (84%) of the inter-scalene patients were hospitalised due to post-operative pain, and 5/33 (15%) due to anaesthetic or medical problems. 2/4 (50%) of hospitalised intra-bursal patients had post-anaesthetic complications, and 2/4(50%) had pre-operative medical problems.

Discussion Inter-scalene analgesia is widely published as the most-effective route for post-shoulder surgery pain control. Our data does not support this view, and intra-bursal analgesia administration was found to be more effective at returning a comfortable patient home on the day of surgery. Our practice now routinely utilises intra-bursal catheters for either bolus analgesia or continuous pumps.