Perioperative Interscalene Block Versus Intra-Articular Injection of Local Anesthetics for Postoperative Analgesia in Shoulder Surgery
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: Up to 70% of patients report moderate to severe pain after shoulder surgery, which can compromise early rehabilitation and functional recuperation. Postoperative shoulder pain control is improved with both interscalene block and intra-articular local anesthetic injection. The present study hypothesized that perioperative interscalene analgesia would offer pain control superior to perioperative intra-articular local anesthetics over the first 24 hours after surgery. METHODS: Sixty patients undergoing shoulder surgery were randomly assigned to 1 of 2 groups: group IS had interscalene block with catheter installation, while group IA received intra-articular local anesthetic, also with catheter installation. All patients received 3 local anesthetic injections: 0.25 mL/kg of 2% lidocaine with epinephrine 2.5 microg/mL immediately before and after surgery, and 0.25 mL/kg of 0.5% bupivacaine with epinephrine 2.5 microg/mL 1 hour after the end of surgery, after which the catheters were removed, and no further local anesthetics were administered. Postoperative pain at rest was evaluated in the postanesthesia care unit (PACU), 3 hours, 6 hours and 24 hours after surgery. The area under the 24 hour pain over time curve was calculated. Hydromorphone consumption in the PACU and over 24 hours was recorded. RESULTS: Pain scores (IS: 0.4 +/- 2 vs. IA: 4 +/- 3, P < .0001) and opioid consumption (IS: 0.7 mg +/- 1.4 vs. IA: 1.5 mg +/- 1.2, P = .02) were significantly higher in the PACU for group IA. However, neither the mean pain scores over the first day after surgery (IS: 5 +/- 2 vs. IA: 5 +/- 3; P = .4) nor 24-hour opioid consumption (IS: 4.4 mg +/- 2.8 vs. IA: 4.2 mg +/- 2.6; P = .4) were significantly higher in group IA. CONCLUSIONS: PACU measurements of immediate postoperative pain and narcotic consumption favor perioperative interscalene analgesia over intra-articular analgesia. This benefit does not translate into lower overall pain for the first 24 hours after surgery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".