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Periarticular infiltration analgesia for major shoulder surgery: A systematic review and meta-analysis of randomized controlled trials
Session: EX-03
Thur, Nov. 16, 6:00-6:15 pm
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Periarticular Infiltration Analgesia for Ambulatory Shoulder Surgery

 

Eric M. Yung, BHSc, MD (Cand.)1, Richard Brull, MD, FRCPC1,2, Faraj W. Abdallah, BSc, MD1,3,4

 

1Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada; 2Department of Anesthesia, Women’s College Hospital, Toronto, Ontario, Canada; 3Department of Anesthesia and the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada; 4 Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada

Introduction

•Orthopedic shoulder surgery is associated with significant postoperative pain that can interfere with patient comfort and functional recovery1
•Ultrasound-guided interscalene brachial plexus block (ISB) is the current gold standard, but is invasive and associated with significant risks2
•Periarticular infiltration analgesia (PIA) is a novel, less-invasive technique involving local anesthetic injection directly into sites of surgical trauma
•This systematic review and meta-analysis aimed to determine the efficacy of PIA in the setting of ambulatory patients undergoing shoulder surgery
 
Methods
 
•We sought randomized controlled trials of adults undergoing ambulatory shoulder surgery
•Studies compared PIA to either ISB (single-shot or continuous) or to Control (no intervention, placebo, or oral or intravenous analgesics)
•The primary outcome was cumulative analgesic consumption in the first 24h postoperatively
•Secondary outcomes included:
ØPain scores at rest during first 48h postoperatively
ØIncidence of postoperative nausea and vomiting, respiratory depression, and ISB-related paresthesias
 
Results
 
•Seven studies (383 patients) met the inclusion. These included 187 receiving PIA, 100 receiving ISB, and 96 receiving Control treatments
•Compared to Control, PIA administration significantly reduced cumulative 24h analgesic consumption and pain scores in the first 6h postoperatively
•Compared to ISB,  there were no significant difference in any of the pooled outcomes examined
Discussion
 
•In a limited sample size, PIA provided superior postoperative analgesia to Control groups and was not significantly different from ISB groups
•Our findings support the potential of PIA as an alternative modality of providing postoperative analgesia following orthopedic shoulder surgery
•Good evidence already exists to support the use of similar local infiltration techniques in orthopedic surgeries of the knee3,4
•Intra-articular analgesia was previously thought to represent an effective local technique but has since been associated with chondrotoxicity5
•The small number and size of trials examining PIA significantly limits confidence in the analysis, and further work is both needed and ongoing
 
Conclusion
 
1.This limited review provides support for the potential utility of PIA as a novel technique of postoperative analgesia in shoulder surgery
2.Further work is needed to definitively outline the benefits, indications, and technique of administering PIA
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