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Continuous interscalene brachial plexus blockade is associated with reduced length of stay after shoulder arthroplasty

P N Chalmers, D Salazar, M E Fingerman, J D Keener, A Chamberlain
Orthopaedics & Traumatology, Surgery & Research: OTSR 2017 July 6

BACKGROUND: Catheter-delivered continuous interscalene anesthesia has demonstrated improved pain control in randomized clinical trials. The purpose of this study is to determine whether the introduction of continuous catheter anesthesia was associated with a change in length of stay (LOS), readmission, rates of discharge home without home health or nursing services, or opioid administration. We hypothesized that the introduction of continuous catheter anesthesia would be associated with a decrease in LOS, readmission, non-home discharge, and opioid administration.

METHODS: During 2012, our center transitioned from ultrasound-guided single-dose interscalene regional anesthesia to combined single-dose anesthesia and additional continuous catheter anesthesia over 48-72hours. This retrospective chart review compared primary shoulder arthroplasties with single-dose anesthesia to those with continuous catheter anesthesia, after excluding the learning curve, with univariate and multivariate analyses.

RESULTS: In total, 1697 patients met criteria, 41% with single-dose anesthesia and 59% with continuous catheter anesthesia. On univariate analysis, the continuous catheter group LOS was 2.2±0.7 day and single-dose group LOS was 2.5±0.8 days (P≤0.001). One day LOS's comprised 1% of the single-dose group and 27% of the continuous catheter group (P<0.001). Anesthesia type remained a significant predictor on multivariate analysis (P<0.001) Readmission at 30 and 90 days (P=0.091 and 0.576), and home discharge (P=0.456) were not different. Opioid administration was higher in the continuous catheter group on univariate analysis (P<0.001), but not on multivariate analysis (P=0.607).

CONCLUSION: In this retrospective review of 1697 primary shoulder arthroplasties performed at our high-volume, referral center, continuous catheter anesthesia was associated with reduced length of stay when compared to single-dose anesthesia.

LEVEL OF EVIDENCE: Therapeutic, level IV.


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