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82
Posters
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Postoperative Pain Management
8. Audit of the analgesic efficacy of suprascapular and brachial plexus nerve blocks P. Hodgkinson1, D. Mulholland1, R. Yamin-Ali1, N. Thompson2 [email protected] 1Department of Anaesthetics, Royal Victoria Hospital, Belfast, UK, 2Consultant Surgeon, Royal Victoria Hospital, Belfast, UK Introduction: It is well documented that post-operative pain and discomfort can be severe (1,2). Pain can interfere with post-operative recovery and rehabilitation with subsequent effects upon duration of hospital stay hospital (1,2). Analgesic options available in our institution include opioids with simple analgesic adjuncts, regional anaesthesia or both. PCA is prescribed for major shoulder procedures to complement regional anaesthetic techniques. Our aim is to audit the analgesic efficacy of suprascapular and brachial plexus nerve blocks in the post-operative period. Methods: 21 patients were followed-up using a retrospective chart review. Subjective scales,e.g. VAS, were not utilised because of the high incidence of pre-operative confusion. Instead, times to first oral and parenteral analgesia in post-operative recovery unit and at the ward level were observed. Results: 71% of nerve blocks administered were suprascapular, 24% axillary and 5% interscalene brachial plexus. 47.6% of patients required no parenteral analgesia and 81% required no oral analgesia in post-operative recovery unit. 52.4% of patients required no parenteral analgesia at ward level and 33.3% required their first oral analgesia at 5-6 hours following discharge from the post-operative recovery unit. Patients receiving wound infiltration, 20% required no parenteral analgesia and 100% required no oral analgesia in post-operative recovery. Complications were minimal comprising of 1 vascular incident (4.76%) and 1 failure (4.76%). Conclusion: In conclusion, suprascapular and brachial plexus nerve blocks are effective and safe modes of post-operative analgesia for shoulder surgery.
References 1. Neal J.M, McDonald S.B, Larkin K, et al. Suprascapular nerve block prolongs analgesia after nonarthroscopic shoulder surgery but does not improve outcome. Anesth Analg 2003; 96:982-986. 2. Ritchie E.D, Tong D, Chung F, et al. Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: A new modality? Anesth Analg 1997; 84:1306-1312.
14. Analgesic efficacy of local anaesthesia in combination with morphine and acetaminophen after breast reconstruction with submuscular implant M.H. Legeby1, G.S. Jurell2, M. Beausang-Linder2, C.I. Olofsson1 [email protected] 1Department of Anesthesia and Intensive Care, Karolinska University Hospital, Stockholm, Sweden, 2Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden Background and Aims: Breast reconstruction with sub-muscular tissue implants is associated with substantial post-operative pain. High pain scores in spite of large opioid consumption indicate that opioids alone or together with acetaminophen are insufficient. The present placebo-controlled study aimed to evaluate the analgesic efficacy of local anaesthesia in combination with paracetamol and morphine. Via an indwelling catheter levobupivacain was repeatedly injected in the operated area. Methods: Forty-three earlier breast cancer operated women, scheduled for unilateral secondary breast reconstruction were randomised to one of two groups. The patients received 15 ml levobupivacain 2.5 mg/ml or placebo in a double-blind manor via an indwelling catheter in the operation area every third hours for 45 hours. The first injection was given immediately after the wound closure. All patients received paracetamol 1g x 4 starting 1 hour before surgery and intravenous patient controlled analgesia (PCA) -administered morphine; 2 mg per dose and 6 minutes lock out time. Visual analogue scale (VAS) was used to assess postoperative pain intensity every hour for six hours and thereafter every third hours for 45 hours. Morphine consumption was recorded. Results: The women in the levobupivacain group (n⫽21) reported significantly lower pain intensity at rest during the first 15 hours after surgery (p ⬍ 0.05). During mobilisation the pain intensity difference was lower for the first 6 hours (p ⫽ 0.01) and for the time interval 18-24 hours (p ⫽ 0.045) in the same group. The total mean (sd) opioid consumption in the levobupivacain and placebo groups was 24.6 mg (22.88) and 33.8 mg (30.82) respectively (p ⫽ 0.283). Conclusions: In pain treatment after breast reconstruction, levobupivacain locally injected every third hours added to oral paracetamol and PCA-administered morphine, resulted in improved pain relief at rest and during mobilisation. The morphine consumption was reduced, however not statistically significant.
Posters
•
Postoperative Pain Management
8. Audit of the analgesic efficacy of suprascapular and brachial plexus nerve blocks P. Hodgkinson1, D. Mulholland1, R. Yamin-Ali1, N. Thompson2 [email protected] 1Department of Anaesthetics, Royal Victoria Hospital, Belfast, UK, 2Consultant Surgeon, Royal Victoria Hospital, Belfast, UK Introduction: It is well documented that post-operative pain and discomfort can be severe (1,2). Pain can interfere with post-operative recovery and rehabilitation with subsequent effects upon duration of hospital stay hospital (1,2). Analgesic options available in our institution include opioids with simple analgesic adjuncts, regional anaesthesia or both. PCA is prescribed for major shoulder procedures to complement regional anaesthetic techniques. Our aim is to audit the analgesic efficacy of suprascapular and brachial plexus nerve blocks in the post-operative period. Methods: 21 patients were followed-up using a retrospective chart review. Subjective scales,e.g. VAS, were not utilised because of the high incidence of pre-operative confusion. Instead, times to first oral and parenteral analgesia in post-operative recovery unit and at the ward level were observed. Results: 71% of nerve blocks administered were suprascapular, 24% axillary and 5% interscalene brachial plexus. 47.6% of patients required no parenteral analgesia and 81% required no oral analgesia in post-operative recovery unit. 52.4% of patients required no parenteral analgesia at ward level and 33.3% required their first oral analgesia at 5-6 hours following discharge from the post-operative recovery unit. Patients receiving wound infiltration, 20% required no parenteral analgesia and 100% required no oral analgesia in post-operative recovery. Complications were minimal comprising of 1 vascular incident (4.76%) and 1 failure (4.76%). Conclusion: In conclusion, suprascapular and brachial plexus nerve blocks are effective and safe modes of post-operative analgesia for shoulder surgery.
References 1. Neal J.M, McDonald S.B, Larkin K, et al. Suprascapular nerve block prolongs analgesia after nonarthroscopic shoulder surgery but does not improve outcome. Anesth Analg 2003; 96:982-986. 2. Ritchie E.D, Tong D, Chung F, et al. Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: A new modality? Anesth Analg 1997; 84:1306-1312.
14. Analgesic efficacy of local anaesthesia in combination with morphine and acetaminophen after breast reconstruction with submuscular implant M.H. Legeby1, G.S. Jurell2, M. Beausang-Linder2, C.I. Olofsson1 [email protected] 1Department of Anesthesia and Intensive Care, Karolinska University Hospital, Stockholm, Sweden, 2Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden Background and Aims: Breast reconstruction with sub-muscular tissue implants is associated with substantial post-operative pain. High pain scores in spite of large opioid consumption indicate that opioids alone or together with acetaminophen are insufficient. The present placebo-controlled study aimed to evaluate the analgesic efficacy of local anaesthesia in combination with paracetamol and morphine. Via an indwelling catheter levobupivacain was repeatedly injected in the operated area. Methods: Forty-three earlier breast cancer operated women, scheduled for unilateral secondary breast reconstruction were randomised to one of two groups. The patients received 15 ml levobupivacain 2.5 mg/ml or placebo in a double-blind manor via an indwelling catheter in the operation area every third hours for 45 hours. The first injection was given immediately after the wound closure. All patients received paracetamol 1g x 4 starting 1 hour before surgery and intravenous patient controlled analgesia (PCA) -administered morphine; 2 mg per dose and 6 minutes lock out time. Visual analogue scale (VAS) was used to assess postoperative pain intensity every hour for six hours and thereafter every third hours for 45 hours. Morphine consumption was recorded. Results: The women in the levobupivacain group (n⫽21) reported significantly lower pain intensity at rest during the first 15 hours after surgery (p ⬍ 0.05). During mobilisation the pain intensity difference was lower for the first 6 hours (p ⫽ 0.01) and for the time interval 18-24 hours (p ⫽ 0.045) in the same group. The total mean (sd) opioid consumption in the levobupivacain and placebo groups was 24.6 mg (22.88) and 33.8 mg (30.82) respectively (p ⫽ 0.283). Conclusions: In pain treatment after breast reconstruction, levobupivacain locally injected every third hours added to oral paracetamol and PCA-administered morphine, resulted in improved pain relief at rest and during mobilisation. The morphine consumption was reduced, however not statistically significant.