Perioperative Pain Management for Total Shoulder Arthroplasty: A Pilot Non-Inferiority Trial
Status:
Not yet recruiting
Trial end date:
2023-11-01
Target enrollment:
Participant gender:
Summary
Total shoulder arthroplasty (TSA) is a common and effective treatment for end-stage shoulder
pathologies. Over the past 25 years, implant designs have evolved and the indications for
joint replacement have expanded significantly to include arthritis, rotator cuff arthropathy,
complex shoulder trauma and trauma sequelae. This has resulted in a worldwide increase in
rates of shoulder replacement surgery. The concomitant increased treatment burden for health
care systems has prompted interest in strategies to improve the effectiveness and efficiency
of patient care such as streamlining intraoperative procedures, mitigating complications, and
reducing length of stay by providing outpatient surgical care. Outpatient lower extremity
arthroplasty is commonplace and provides helpful information that can guide the development
of outpatient TSA such as careful patient selection and the use of standardized perioperative
pain management protocols. In lower extremity arthroplasty, several authors have described
challenges associated with nerve blockade and the advantages of high-volume local
infiltration analgesia (LIA) for outpatient arthroplasty. Proponents of outpatient TSA also
describe the importance of patient selection, standardized perioperative protocols and
implementation of comprehensive perioperative pain management strategies that can include the
use of perioperative ultrasound guided interscalene brachial plexus blockade with a "single
shot" injection, ultrasound guided interscalene brachial plexus blockade with a temporary
indwelling catheter (ISB), LIA near the surgical site, and multimodal postoperative
analgesics.