Related Experiment Video
Updated: Jul 26, 2025
Author Spotlight: Treating Frozen Shoulder with Small Needle Knife Therapy
Published on: November 17, 2023
Periarticular injection in addition to interscalene nerve block can decrease opioid consumption and pain following
Chaiyanun Vijittrakarnrung1, Ryan Freshman2, Christopher Anigwe2
1Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, San Francisco, CA, USA; Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Adding a periarticular injection to an interscalene nerve block significantly reduces postoperative pain and opioid use after shoulder arthroplasty. This combined approach offers a safe and effective strategy for enhanced pain management following TSA.
Area of Science:
- Orthopedics
- Anesthesiology
- Pain Management
Background:
- Interscalene nerve block (INB) provides postoperative analgesia for total shoulder arthroplasty (TSA).
- INB's analgesic effects diminish within 8-24 hours, leading to rebound pain and increased opioid consumption.
- A combination of INB and periarticular injection (PAI) may improve pain control after TSA.
Purpose of the Study:
- To evaluate the efficacy of adding an intraoperative PAI to INB for reducing acute postoperative opioid consumption and pain scores in TSA patients.
- To test the hypothesis that INB + PAI reduces opioid use and pain scores compared to INB alone in the first 24 hours post-surgery.
Main Methods:
- A retrospective review of 130 patients undergoing elective primary TSA was conducted.
- Group 1 received INB (0.5% ropivacaine) alone; Group 2 received INB + PAI (ropivacaine, epinephrine, clonidine, ketorolac).
- Standardized postoperative oral pain medication was administered to all patients. Primary outcome: 24-hour opioid consumption (MEUs); Secondary outcomes: VAS pain scores, operative time, length of stay, complications.
Main Results:
- Patients receiving INB + PAI showed significantly lower 24-hour opioid consumption (38.6 MEU) versus INB alone (60.5 MEU) (P < .001).
- VAS pain scores were significantly lower in the INB + PAI group (2.9) compared to the INB alone group (4.3) (P ≤ .001).
- No significant differences were observed in operative time, length of stay, or perioperative complications between the groups.
Conclusions:
- The addition of intraoperative PAI to INB significantly decreases 24-hour postoperative opioid consumption and pain scores in TSA patients.
- The combined INB + PAI approach was found to be safe, with no increase in acute perioperative complications.
- Intraoperative PAI combined with INB is a safe and effective method for managing acute postoperative pain following total shoulder arthroplasty.
