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456: Suprascapular Nerve Block for Pain Relief of Frozen Shoulder
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Posters
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Peripheral Nerve Blocks
456. Suprascapular nerve block for pain relief of frozen shoulder E. Antonopoulou1, A. Tataraki1, S. Poulaki1, M. Papadopoulou1, V. Karamoulas2, K. Papaioannou1 1General Hospital Xanthi, Anaesthetic, Xanthi, Greece, 2General Hospital Xanthi, Orthopaedic, Xanthi, Greece Background and Aims: To assess the effectiveness of suprascapular nerve block to relieve pain after passive manipulation of the shoulder under General Anaesthesia for treatment of frozen shoulder. Methods: In a prospective trial we randomized 27 patients, ASA I-III, aged 47-73yrs in two groups. All patients underwent manipulation of their shoulder under GA with fentanyl 0.2g/kg and propofol 2.5 mg/kg. They were premedicated with iv midazolam 0.02mg/kg. In group A (n⫽12) the suprascapular nerve block was performed at the end of the manipulation. In group B (n⫽ 15) the block was performed 20-30 min before GA. The suprascapular nerve block was performed with the patient in the sitting position and the nerve was identified with a stimulator using an aseptic technique. A bolus dose of 20 ml levobupivacaine 5mg/ml was administered. We assessed the pain score and the consumption of morphine in the two groups for the next 2 hours. There were no side effects. Results: In group A all patients had severe pain with VAS score 8-10 while mean morphine consumption was 12.3⫾ 3.6 mg with poor pain relief. In group B patients had VAS score 2-5, and only two required morphine 4 mg for pain relief. The VAS score difference between the two groups was statistically significant as well as the morphine consumption (p⬍ 0.05). Conclusions: This study demonstrates that preoperative suprascapular blockade provides significantly better postoperative analgesia probably due to the pre-emptive effect of the local anaesthetic.
472. Regional block anaesthesia vs general anaesthesia for carotid endarterectomy N. Andrade, J. Ferreira, J. Mourao, S. Gomes, G. Afonso, J. Tavares Hospital de S. Joa˜o, Porto, Portugal Background and Aims: Carotid Endarterectomy (CE) is a preventive surgery which reduces the incidence of cerebral tromboembolic events. However, it comprises an increased risk of perioperatory stroke and acute myocardial infarct. Though CE has been done since 1954, some of its aspects remain undefined, with great controversy about the choice of anaesthetic technique.Our aim is to compare peri-operatory morbility, mortality, postoperatory length of stay, intra-operatory clamp time and hemodynamic instability, in a Portuguese hospital. Methods: Retrospective study of 260 CE’s perfomed between 2002/01/01 and 2007/08/31 at Hospital S. Joa˜o. Data collected included: demographics, ASA score, type of anaesthesia, peri-operatory morbility, mortality, length of stay, intra-operatory clamp time and hemodynamic instability. Statistical analysis: SPSS 15.0. Results: Ninety (34.6%) of the 260 procedures were done under general anaesthesia - Group I - and 170 (65.4%) under regional block anaesthesia (deep and superficial cervical plexus) - Group II. Both groups had similar age, sex, ASA score and pre-operative conditions. Results showed that Group I had higher peri-operatory morbility (33.3% vs 11.2% - p⬍ 0.05), higher clamp time (47.5min vs 40.9min - p⬍ 0.05), higher length of ICU stay (1.99 days vs 0.35days - p⬍ 0.05) and higher total length of stay (6.52 days vs 3.28 days - p⬍ 0.05). Group I also had a higher need of adrenergic agonists (37.8% vs 13.5% - p⬍ 0.05) but a lower need of hypotensive drugs (24.4% vs 39.4% - p⬍ 0.05). Mortality occurrences are insufficient for any further analysis. Conclusions: Our results showed that, in our hospital’s experience, use of regional block anaesthesia is advantageous relatively to general anaesthesia concerning peri-operatory morbility, length of ICU and total length of stay. It also showed a lower need for adrenergic agonists intraoperatory. The number or mortality occurrences is still not enough to achieve any sort of conclusion.
Posters
•
Peripheral Nerve Blocks
456. Suprascapular nerve block for pain relief of frozen shoulder E. Antonopoulou1, A. Tataraki1, S. Poulaki1, M. Papadopoulou1, V. Karamoulas2, K. Papaioannou1 1General Hospital Xanthi, Anaesthetic, Xanthi, Greece, 2General Hospital Xanthi, Orthopaedic, Xanthi, Greece Background and Aims: To assess the effectiveness of suprascapular nerve block to relieve pain after passive manipulation of the shoulder under General Anaesthesia for treatment of frozen shoulder. Methods: In a prospective trial we randomized 27 patients, ASA I-III, aged 47-73yrs in two groups. All patients underwent manipulation of their shoulder under GA with fentanyl 0.2g/kg and propofol 2.5 mg/kg. They were premedicated with iv midazolam 0.02mg/kg. In group A (n⫽12) the suprascapular nerve block was performed at the end of the manipulation. In group B (n⫽ 15) the block was performed 20-30 min before GA. The suprascapular nerve block was performed with the patient in the sitting position and the nerve was identified with a stimulator using an aseptic technique. A bolus dose of 20 ml levobupivacaine 5mg/ml was administered. We assessed the pain score and the consumption of morphine in the two groups for the next 2 hours. There were no side effects. Results: In group A all patients had severe pain with VAS score 8-10 while mean morphine consumption was 12.3⫾ 3.6 mg with poor pain relief. In group B patients had VAS score 2-5, and only two required morphine 4 mg for pain relief. The VAS score difference between the two groups was statistically significant as well as the morphine consumption (p⬍ 0.05). Conclusions: This study demonstrates that preoperative suprascapular blockade provides significantly better postoperative analgesia probably due to the pre-emptive effect of the local anaesthetic.
472. Regional block anaesthesia vs general anaesthesia for carotid endarterectomy N. Andrade, J. Ferreira, J. Mourao, S. Gomes, G. Afonso, J. Tavares Hospital de S. Joa˜o, Porto, Portugal Background and Aims: Carotid Endarterectomy (CE) is a preventive surgery which reduces the incidence of cerebral tromboembolic events. However, it comprises an increased risk of perioperatory stroke and acute myocardial infarct. Though CE has been done since 1954, some of its aspects remain undefined, with great controversy about the choice of anaesthetic technique.Our aim is to compare peri-operatory morbility, mortality, postoperatory length of stay, intra-operatory clamp time and hemodynamic instability, in a Portuguese hospital. Methods: Retrospective study of 260 CE’s perfomed between 2002/01/01 and 2007/08/31 at Hospital S. Joa˜o. Data collected included: demographics, ASA score, type of anaesthesia, peri-operatory morbility, mortality, length of stay, intra-operatory clamp time and hemodynamic instability. Statistical analysis: SPSS 15.0. Results: Ninety (34.6%) of the 260 procedures were done under general anaesthesia - Group I - and 170 (65.4%) under regional block anaesthesia (deep and superficial cervical plexus) - Group II. Both groups had similar age, sex, ASA score and pre-operative conditions. Results showed that Group I had higher peri-operatory morbility (33.3% vs 11.2% - p⬍ 0.05), higher clamp time (47.5min vs 40.9min - p⬍ 0.05), higher length of ICU stay (1.99 days vs 0.35days - p⬍ 0.05) and higher total length of stay (6.52 days vs 3.28 days - p⬍ 0.05). Group I also had a higher need of adrenergic agonists (37.8% vs 13.5% - p⬍ 0.05) but a lower need of hypotensive drugs (24.4% vs 39.4% - p⬍ 0.05). Mortality occurrences are insufficient for any further analysis. Conclusions: Our results showed that, in our hospital’s experience, use of regional block anaesthesia is advantageous relatively to general anaesthesia concerning peri-operatory morbility, length of ICU and total length of stay. It also showed a lower need for adrenergic agonists intraoperatory. The number or mortality occurrences is still not enough to achieve any sort of conclusion.